Provider Demographics
NPI:1043253503
Name:HERTERT, MATTHEW DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DEAN
Last Name:HERTERT
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:PO BOX 680
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-0680
Mailing Address - Country:US
Mailing Address - Phone:814-466-2000
Mailing Address - Fax:
Practice Address - Street 1:128 E BOAL AVE
Practice Address - Street 2:
Practice Address - City:BOALSBURG
Practice Address - State:PA
Practice Address - Zip Code:16827-1442
Practice Address - Country:US
Practice Address - Phone:814-466-2000
Practice Address - Fax:814-466-2228
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor