Provider Demographics
NPI:1629449913
Name:HERNDON, NATHAN (DC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:HERNDON
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 1:203 G ST STE B
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2036
Mailing Address - Country:US
Mailing Address - Phone:949-933-2218
Mailing Address - Fax:
Practice Address - Street 1:203 G ST STE B
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2036
Practice Address - Country:US
Practice Address - Phone:949-933-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor