Provider Demographics
NPI:1235290552
Name:HERZOG, JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:HERZOG
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 1:555 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2975
Mailing Address - Country:US
Mailing Address - Phone:732-431-2611
Mailing Address - Fax:732-431-5499
Practice Address - Street 1:555 IRON BRIDGE RD
Practice Address - Street 2:SUITE 18
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2975
Practice Address - Country:US
Practice Address - Phone:732-431-2611
Practice Address - Fax:732-431-5499
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC3531111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223623951OtherFEDERAL TAX ID NUMBER
NJT45704Medicare UPIN
NJ223623951OtherFEDERAL TAX ID NUMBER