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General NPI Number Information
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NPI Number | 1417431610
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Entity Type | Organization
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Legal Business Name | HARTLEY CHIROPRACTIC WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 3390 COACHMAN RD STE 214
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City | EAGAN
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State | MN
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Zip | 55121-1800
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Country | US
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Telephone | 651-452-4220
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Fax | 651-452-3829
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Provider Business Mailing Address
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Address Line | 1681 EVERGREEN DR
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City | WOODBURY
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State | MN
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Zip | 55125-2303
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Country | US
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Telephone | 651-452-4220
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Fax | 651-452-3829
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDI HARTLEY
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Credential | DC
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Telephone | 651-452-4220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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