Provider Demographics
NPI:1295832822
Name:HERMAN, MARK F (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:HERMAN
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 1:962 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1858
Mailing Address - Country:US
Mailing Address - Phone:954-384-8095
Mailing Address - Fax:954-756-7379
Practice Address - Street 1:301 NW 84TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1807
Practice Address - Country:US
Practice Address - Phone:954-693-7601
Practice Address - Fax:954-756-7379
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2009-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH0006003OtherSTATE LICENSE NUMBER
FLU11732Medicare UPIN
FL22598Medicare ID - Type Unspecified