Provider Demographics
NPI:1437139722
Name:HERMANSON, KAREN E (DC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:HERMANSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6611
Mailing Address - Country:US
Mailing Address - Phone:619-447-3779
Mailing Address - Fax:619-447-3899
Practice Address - Street 1:983 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6611
Practice Address - Country:US
Practice Address - Phone:619-447-3779
Practice Address - Fax:619-447-3899
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28086111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU99155Medicare UPIN
CADC28086Medicare ID - Type Unspecified