Provider Demographics
NPI:1376968412
Name:JAMES C HERNDON JR DC P A
Entity Type:Organization
Organization Name:JAMES C HERNDON JR DC P A
Other - Org Name:HERNDON CHIROPRACTIC CLINIC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:407-345-0508
Mailing Address - Street 1:7575 DR PHILLIPS BLVD STE 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 STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 5763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22198OtherBCBS PROVIDER ID NUMBER
FL22198Medicare PIN
FL22198OtherBCBS PROVIDER ID NUMBER