Provider Demographics
NPI:1326102922
Name:SCOTT HERMAN, DC, PA
Entity Type:Organization
Organization Name:SCOTT HERMAN, DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-917-4343
Mailing Address - Street 1:4400 W SAMPLE RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3470
Mailing Address - Country:US
Mailing Address - Phone:954-917-4343
Mailing Address - Fax:954-917-7977
Practice Address - Street 1:4400 W SAMPLE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3470
Practice Address - Country:US
Practice Address - Phone:954-917-4343
Practice Address - Fax:954-917-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55658Medicare PIN