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General NPI Number Information
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NPI Number | 1699924084
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Entity Type | Individual
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Provider Name | KEITH ROBERT HARTLEY DC
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Gender | Male
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 1318 CHICAGO AVE
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City | EVANSTON
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State | IL
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Zip | 60201-4725
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Country | US
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Telephone | 847-475-4960
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Fax |
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Provider Business Mailing Address
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Address Line | 4913 N ASHLAND AVE UNIT 3
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City | CHICAGO
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State | IL
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Zip | 60640-3416
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Country | US
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Telephone | 630-205-9601
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 038.011247
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License Number State | IL
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