Provider Demographics
NPI:1619087830
Name:CONGRAM, HERBERT F (DC)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:F
Last Name:CONGRAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:HERB.
Other - Middle Name:F
Other - Last Name:CONGRAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:219 HAILE BOOKER RD
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8725
Mailing Address - Country:US
Mailing Address - Phone:229-423-0550
Mailing Address - Fax:229-424-0923
Practice Address - Street 1:219 HAILE BOOKER RD
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8725
Practice Address - Country:US
Practice Address - Phone:229-423-0550
Practice Address - Fax:229-424-0923
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor