Provider Demographics
NPI:1689762676
Name:ROBERT HERMANN DC SC
Entity Type:Organization
Organization Name:ROBERT HERMANN DC SC
Other - Org Name:CHIROCARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC DABCO
Authorized Official - Phone:309-663-2423
Mailing Address - Street 1:2415 E WASHINGTON STREET STE F
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704
Mailing Address - Country:US
Mailing Address - Phone:309-663-2423
Mailing Address - Fax:309-662-0223
Practice Address - Street 1:2415 E WASHINGTON STREET STE F
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704
Practice Address - Country:US
Practice Address - Phone:309-663-2423
Practice Address - Fax:309-662-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05732056OtherBLUE SHIELD
ILDD8148Medicare ID - Type UnspecifiedRAILROAD MEDICARE
208375Medicare ID - Type Unspecified
T38109Medicare UPIN