Provider Demographics
NPI:1477726164
Name:HERBST, ROGER W (DC)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:W
Last Name:HERBST
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 1:909 SE EVERETT MALL WAY
Mailing Address - Street 2:SUITE C 310
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3746
Mailing Address - Country:US
Mailing Address - Phone:425-355-7800
Mailing Address - Fax:
Practice Address - Street 1:909 SE EVERETT MALL WAY
Practice Address - Street 2:SUITE C 310
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3746
Practice Address - Country:US
Practice Address - Phone:425-355-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor