Provider Demographics
NPI:1669641528
Name:HERBERT, JONATHAN BARRET (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BARRET
Last Name:HERBERT
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 1:4897 MILLER TRUNK HWY
Mailing Address - Street 2:SUITE 228
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1584
Mailing Address - Country:US
Mailing Address - Phone:218-727-3343
Mailing Address - Fax:218-206-8345
Practice Address - Street 1:4897 MILLER TRUNK HWY
Practice Address - Street 2:SUITE 228
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-1584
Practice Address - Country:US
Practice Address - Phone:218-727-3343
Practice Address - Fax:218-206-8345
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30806111N00000X
MN5484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor