MEDICARE: CHRISTOPHER J HARTLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3755	MN

General Provider Information

NPI Number	:	1306343819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER J HARTLEY

Provider Business Mailing Address
First Line	:	3257 19TH ST NW STE 1
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-6797
Country	:	US
Telephone Number	:	507-292-1800
Fax Number	:	507-292-1804

Provider Business Practice Location Address
First Line	:	3257 19TH ST NW STE 1
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-6797
Country	:	US
Telephone Number	:	507-292-1800
Fax Number	:	507-292-1804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	04/11/2018

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