Provider Demographics
NPI:1356500482
Name:BARTLEY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:BARTLEY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-482-6600
Mailing Address - Street 1:629 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3040
Mailing Address - Country:US
Mailing Address - Phone:812-482-6600
Mailing Address - Fax:
Practice Address - Street 1:629 MAIN ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3040
Practice Address - Country:US
Practice Address - Phone:812-482-6600
Practice Address - Fax:812-482-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001246A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN212120Medicare UPIN