Provider Demographics
NPI:1750473443
Name:HERRON, KENT A (DC)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:A
Last Name:HERRON
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 1:607 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-2537
Mailing Address - Country:US
Mailing Address - Phone:618-937-3509
Mailing Address - Fax:618-937-3500
Practice Address - Street 1:607 W OAK ST
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-2537
Practice Address - Country:US
Practice Address - Phone:618-937-3509
Practice Address - Fax:618-937-3500
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038006817Medicaid
IL350038040OtherRR MEDICARE
IL1517948OtherFUNDS
IL038006817Medicaid
IL1517948OtherFUNDS