Provider Demographics
NPI:1346305844
Name:HERTENSTERN, DENNIS WARREN (DC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:WARREN
Last Name:HERTENSTERN
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 1:1212 FARMERS LANE
Mailing Address - Street 2:STE 2
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6747
Mailing Address - Country:US
Mailing Address - Phone:707-566-7396
Mailing Address - Fax:
Practice Address - Street 1:1212 FARMERS LANE
Practice Address - Street 2:STE 2
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6747
Practice Address - Country:US
Practice Address - Phone:707-566-7396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor