Healthcare Provider Details

I. General information

NPI: 1275576472
Provider Name (Legal Business Name): ALAN DAVID HARTLEY PH.D., DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 LATITUDE LN SUITE 104
LAKE WYLIE SC
29710-8124
US

IV. Provider business mailing address

244 LATITUDE LN SUITE 104
LAKE WYLIE SC
29710-8124
US

V. Phone/Fax

Practice location:
  • Phone: 803-831-6500
  • Fax: 803-831-6383
Mailing address:
  • Phone: 803-831-6500
  • Fax: 803-831-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2361
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: