MEDICARE: DR. DENIS WILLIAM HARTLEY JR. D.C.

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	CE005373	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4408241	OTHER	MO	UNITED HEALTH CARE
2	22444	OTHER	MO	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1679649198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENIS WILLIAM HARTLEY JR. D.C.

Provider Business Mailing Address
First Line	:	11935 OLIVE BLVD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6729
Country	:	US
Telephone Number	:	314-432-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	11935 OLIVE BLVD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6729
Country	:	US
Telephone Number	:	314-432-0005
Fax Number	:

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/08/2007

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