Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 08001622 | IN |
N | 111NN1001X | Nutrition | 2301007361 | MI |
N | 111NN1001X | Nutrition | 3042 | WI |
N | 111NS0005X | Chiropractic Sports Physician | 3164 | MN |
NPI | 1073610010 |
---|---|
Provider Name | Dr. Michael Anthony Hartle |
First Address | Fort Wayne, IN 46807-2561 |
Second Address | Fort Wayne, IN 46804-6809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U46598 | (02) | IN |