Provider Demographics
NPI:1316028343
Name:HERTA, KELLY L (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:HERTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:27009 BIG RAPIDS LOOP UNIT 38
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-2661
Mailing Address - Country:US
Mailing Address - Phone:661-255-5737
Mailing Address - Fax:661-255-5737
Practice Address - Street 1:27875 SMYTH DR STE 100
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-6064
Practice Address - Country:US
Practice Address - Phone:661-295-5200
Practice Address - Fax:661-295-5216
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA30274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor