Provider Demographics
NPI:1346254067
Name:HERNDON, JAMES C JR (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:HERNDON
Suffix:JR
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 1:7575 DR PHILLIPS BLVD., #110
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7221
Mailing Address - Country:US
Mailing Address - Phone:407-345-0508
Mailing Address - Fax:407-345-0509
Practice Address - Street 1:7575 DR PHILLIPS BLVD., #110
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7221
Practice Address - Country:US
Practice Address - Phone:407-345-0508
Practice Address - Fax:407-345-0509
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22198Medicare PIN
FL22198OtherBLUE CROSS & BLUE SHIELD