Provider Demographics
NPI:1871734905
Name:HARTENBURG, MATTHEW RONALD (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RONALD
Last Name:HARTENBURG
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 1:14400 JOHN HUMPHREY DR
Mailing Address - Street 2:STE 110
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2897
Mailing Address - Country:US
Mailing Address - Phone:708-349-0040
Mailing Address - Fax:708-349-0060
Practice Address - Street 1:14400 JOHN HUMPHREY DR
Practice Address - Street 2:STE 110
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2897
Practice Address - Country:US
Practice Address - Phone:708-349-0040
Practice Address - Fax:708-349-0060
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor