Provider Demographics
NPI:1932838976
Name:HART, IAN (DC)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:HART
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 1:7605 NICHOLAS WAY
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-7545
Mailing Address - Country:US
Mailing Address - Phone:507-696-1786
Mailing Address - Fax:
Practice Address - Street 1:12982 VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3657
Practice Address - Country:US
Practice Address - Phone:952-456-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6992111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician