Provider Demographics
NPI:1962952101
Name:HARTLEY CHIROPRACTIC AND SCOLIOSIS CENTER, P.A.
Entity type:Organization
Organization Name:HARTLEY CHIROPRACTIC AND SCOLIOSIS CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-679-3233
Mailing Address - Street 1:1740 TREE BLVD
Mailing Address - Street 2:#115
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-5720
Mailing Address - Country:US
Mailing Address - Phone:904-679-3233
Mailing Address - Fax:
Practice Address - Street 1:1740 TREE BLVD
Practice Address - Street 2:#115
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-5720
Practice Address - Country:US
Practice Address - Phone:904-679-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH06696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty