Healthcare Provider Details

I. General information

NPI: 1972875276
Provider Name (Legal Business Name): HARTMAN CHIROPRACTIC & REHABILITATION, INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 WISCONSIN AVE
OOSTBURG WI
53070-1104
US

IV. Provider business mailing address

1205 WISCONSIN AVE
OOSTBURG WI
53070-1104
US

V. Phone/Fax

Practice location:
  • Phone: 920-564-6672
  • Fax: 920-564-6673
Mailing address:
  • Phone: 920-564-6672
  • Fax: 920-564-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3503-12
License Number StateWI

VIII. Authorized Official

Name: DR. ERIC JAMES HARTMAN
Title or Position: OWNER
Credential: D.C.
Phone: 920-564-6672