Provider Demographics
NPI:1023028271
Name:HERZBERG, KASEY GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:KASEY
Middle Name:GEORGE
Last Name:HERZBERG
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 1:112 N 16TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-1601
Mailing Address - Country:US
Mailing Address - Phone:712-542-1404
Mailing Address - Fax:712-542-2815
Practice Address - Street 1:112 N 16TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1601
Practice Address - Country:US
Practice Address - Phone:712-542-1404
Practice Address - Fax:712-542-2815
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0298257Medicaid
IAI8333Medicare ID - Type Unspecified