Provider Demographics
NPI:1568611242
Name:BENJAMIN J HERMAN DC INC
Entity Type:Organization
Organization Name:BENJAMIN J HERMAN DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-356-8444
Mailing Address - Street 1:1217 S JEFFERSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-3886
Mailing Address - Country:US
Mailing Address - Phone:260-356-8444
Mailing Address - Fax:260-356-8444
Practice Address - Street 1:1217 S JEFFERSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-3886
Practice Address - Country:US
Practice Address - Phone:260-356-8444
Practice Address - Fax:260-356-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002398A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200977190BMedicaid
IN200977190BMedicaid