Provider Demographics
NPI:1366830663
Name:HERLYN, BRETT
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:HERLYN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:SD
Mailing Address - Zip Code:57053-2170
Mailing Address - Country:US
Mailing Address - Phone:605-201-9964
Mailing Address - Fax:
Practice Address - Street 1:569 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:SD
Practice Address - Zip Code:57053-2170
Practice Address - Country:US
Practice Address - Phone:605-201-9964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor