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General NPI Number Information
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NPI Number | 1427117902
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Entity Type | Organization
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Legal Business Name | HARTLEY CHIROPRACTIC CLINIC INC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 110 S 1ST AVE E
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City | HARTLEY
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State | IA
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Zip | 51346-1435
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Country | US
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Telephone | 712-278-2364
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Fax | 712-728-3409
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Provider Business Mailing Address
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Address Line | 110 S 1ST AVE E
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City | HARTLEY
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State | IA
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Zip | 51346-1435
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Country | US
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Telephone | 712-278-2364
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Fax | 712-728-3409
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TADD LEE KNOBLOCH
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Credential | DC
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Telephone | 712-728-2364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | A06014
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License Number State | IA
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