Healthcare Provider Details

I. General information

NPI: 1669776621
Provider Name (Legal Business Name): LEO JOSEPH HART DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SE DIXIE HWY SUITE 2
STUART FL
34994-3054
US

IV. Provider business mailing address

500 SE DIXIE HWY SUITE 2
STUART FL
34994-3054
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-7701
  • Fax: 772-220-4473
Mailing address:
  • Phone: 772-287-7701
  • Fax: 772-220-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7783
License Number StateFL

VIII. Authorized Official

Name: DR. LEO JOSEPH HART
Title or Position: PRESIDENT
Credential: D.C.
Phone: 772-287-7701