Provider Demographics
NPI:1134141435
Name:HERBERT, DAVID MILES (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MILES
Last Name:HERBERT
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 1:33733 YUCAIPA BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2256
Mailing Address - Country:US
Mailing Address - Phone:909-797-0103
Mailing Address - Fax:909-797-0105
Practice Address - Street 1:33733 YUCAIPA BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2256
Practice Address - Country:US
Practice Address - Phone:909-797-0103
Practice Address - Fax:909-797-0105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor