Provider Demographics
NPI:1154506798
Name:HERTZBERG HEALTHCARE RES, INC
Entity Type:Organization
Organization Name:HERTZBERG HEALTHCARE RES, INC
Other - Org Name:CHIROCARE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HERTZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-899-0882
Mailing Address - Street 1:1941 W GUADALUPE RD STE 117
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1941 W GUADALUPE RD STE 117
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7484
Practice Address - Country:US
Practice Address - Phone:480-899-0882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ101987Medicare PIN