Provider Demographics
NPI:1659578185
Name:HERNDON CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:HERNDON CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KALEN
Authorized Official - Middle Name:HELENA
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-537-3451
Mailing Address - Street 1:1044 C ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-5125
Mailing Address - Country:US
Mailing Address - Phone:510-537-3451
Mailing Address - Fax:
Practice Address - Street 1:1044 C ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-5125
Practice Address - Country:US
Practice Address - Phone:510-537-3451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8450111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1144374240OtherNPI TYPE 1
CADC0084500Medicare UPIN
CA1144374240OtherNPI TYPE 1