Provider Demographics
NPI:1083653158
Name:HERMANN, ROBERT J (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:HERMANN
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 1:5 BENT TREE LN
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:IL
Mailing Address - Zip Code:61776-7511
Mailing Address - Country:US
Mailing Address - Phone:309-728-2621
Mailing Address - Fax:309-662-0223
Practice Address - Street 1:2415 E WASHINGTON ST
Practice Address - Street 2:SUITE 'F'
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-4473
Practice Address - Country:US
Practice Address - Phone:309-663-2423
Practice Address - Fax:309-662-0223
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005048111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001213OtherHEALTH ALLIANCE
IL9900HOtherCATERPILLAR
IL0573 2056OtherBLUE CROSS BLUESHIELD
IL0573 2056OtherBLUE CROSS BLUESHIELD
ILT38109Medicare UPIN
IL9900HOtherCATERPILLAR