Provider Demographics
NPI:1073730941
Name:HERBERT CHIROPRACTIC OFFICES
Entity Type:Organization
Organization Name:HERBERT CHIROPRACTIC OFFICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-683-4935
Mailing Address - Street 1:3730 PONTIAC AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-4439
Mailing Address - Country:US
Mailing Address - Phone:951-683-4935
Mailing Address - Fax:951-684-1551
Practice Address - Street 1:3730 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-4439
Practice Address - Country:US
Practice Address - Phone:951-683-4935
Practice Address - Fax:951-684-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49208YMedicare ID - Type Unspecified