Provider Demographics
NPI:1083346019
Name:HARTLAUB, MICHAEL RYAN (LAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RYAN
Last Name:HARTLAUB
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 SAWMILL COMMONS LN APT L
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8592
Mailing Address - Country:US
Mailing Address - Phone:330-819-2765
Mailing Address - Fax:
Practice Address - Street 1:75 CLAIREDAN DR STE G
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-3505
Practice Address - Country:US
Practice Address - Phone:614-505-9363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000309171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist