Provider Demographics
NPI:1437290434
Name:HERBSTSOMER, JOHN DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DANIEL
Last Name:HERBSTSOMER
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 1:3903 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-4507
Mailing Address - Country:US
Mailing Address - Phone:301-829-5954
Mailing Address - Fax:
Practice Address - Street 1:3903 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-4507
Practice Address - Country:US
Practice Address - Phone:301-829-5954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCS2170001OtherCAREFIRST BCBS DC NAT CAP
MD671937OtherUNITED HEALTHCARE
MDM237OtherCAREFIRST BCBS
MD237707OtherMAMSI
MD671937OtherUNITED HEALTHCARE