Provider Demographics
NPI:1568900025
Name:HERENDEEN, JOSHUA RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:RICHARD
Last Name:HERENDEEN
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 1:120 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1304
Mailing Address - Country:US
Mailing Address - Phone:585-690-8048
Mailing Address - Fax:
Practice Address - Street 1:120 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1304
Practice Address - Country:US
Practice Address - Phone:585-690-8048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70012913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor