Provider Demographics
NPI:1386773232
Name:HARTZOG, RAPHAEL V (DC)
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:V
Last Name:HARTZOG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1904
Mailing Address - Country:US
Mailing Address - Phone:413-781-8900
Mailing Address - Fax:413-781-6200
Practice Address - Street 1:4 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1904
Practice Address - Country:US
Practice Address - Phone:413-781-8900
Practice Address - Fax:413-781-6200
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor