Provider Demographics
NPI:1619340080
Name:HERMAN, CHARLENE MAY (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:MAY
Last Name:HERMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:MAY
Other - Last Name:DUMORTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4311 W 6TH ST
Mailing Address - Street 2:STE C
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3965
Mailing Address - Country:US
Mailing Address - Phone:785-856-0423
Mailing Address - Fax:
Practice Address - Street 1:4311 W 6TH ST
Practice Address - Street 2:STE C
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3965
Practice Address - Country:US
Practice Address - Phone:785-856-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-07
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor