Provider Demographics
NPI:1750462115
Name:HERRERA, RUDOLPH ROBERT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:ROBERT
Last Name:HERRERA
Suffix:JR
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 1:7900 LIMONITE AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-6169
Mailing Address - Country:US
Mailing Address - Phone:951-685-5345
Mailing Address - Fax:951-685-5393
Practice Address - Street 1:7900 LIMONITE AVE
Practice Address - Street 2:SUITE L
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-6169
Practice Address - Country:US
Practice Address - Phone:951-685-5345
Practice Address - Fax:951-685-5393
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29302111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V04896Medicare UPIN
CAWDC29302AMedicare ID - Type Unspecified