Provider Demographics
NPI:1467551978
Name:HERRMANN, MARK ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:HERRMANN
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 1:3320 CLINTON PARKWAY CT STE 200
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2650
Mailing Address - Country:US
Mailing Address - Phone:785-843-1188
Mailing Address - Fax:785-843-1166
Practice Address - Street 1:3320 CLINTON PARKWAY CT STE 200
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2650
Practice Address - Country:US
Practice Address - Phone:785-843-1188
Practice Address - Fax:785-843-1166
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS01-04252OtherSTATE OF KANSAS
KSCM00101580OtherNATIONAL CHIROPRACTIC MUT
KS017534OtherMEDICARE GROUP PTAN
KS062196OtherMEDICARE PTAN
MOCE006571OtherSTATE OF MISSOURI
OH2855OtherSTATE OF OHIO