Provider Demographics
NPI:1750486098
Name:HERMAN, JAN BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:BRIAN
Last Name:HERMAN
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 1:1718 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1026
Mailing Address - Country:US
Mailing Address - Phone:570-424-5433
Mailing Address - Fax:570-424-5764
Practice Address - Street 1:1718 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1026
Practice Address - Country:US
Practice Address - Phone:570-424-5433
Practice Address - Fax:570-424-5764
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC3797L111N00000X
PAAJ-3797-L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHE445069Medicare PIN