Healthcare Provider Details

I. General information

NPI: 1518927243
Provider Name (Legal Business Name): GARRET M HAUPTMAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 PENNSYLVANIA AVE UNIT C6
PHILADELPHIA PA
19130-2348
US

IV. Provider business mailing address

2601 PENNSYLVANIA AVE UNIT C6
PHILADELPHIA PA
19130-2348
US

V. Phone/Fax

Practice location:
  • Phone: 215-564-4880
  • Fax: 215-564-4890
Mailing address:
  • Phone: 215-564-4880
  • Fax: 215-564-4890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC8616
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: