Provider Demographics
NPI:1427117902
Name:HARTLEY CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:HARTLEY CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TADD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KNOBLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-728-2364
Mailing Address - Street 1:110 S 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:HARTLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51346-1435
Mailing Address - Country:US
Mailing Address - Phone:712-278-2364
Mailing Address - Fax:712-728-3409
Practice Address - Street 1:110 S 1ST AVE E
Practice Address - Street 2:
Practice Address - City:HARTLEY
Practice Address - State:IA
Practice Address - Zip Code:51346-1435
Practice Address - Country:US
Practice Address - Phone:712-278-2364
Practice Address - Fax:712-728-3409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06014111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1151852Medicaid
IAU65609Medicare UPIN
IA1151852Medicaid