Provider Demographics
NPI:1801830989
Name:HERBENER, PAUL J (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:HERBENER
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 1:12 ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-5511
Mailing Address - Country:US
Mailing Address - Phone:570-836-0732
Mailing Address - Fax:
Practice Address - Street 1:112 RIVER ST
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-1799
Practice Address - Country:US
Practice Address - Phone:570-836-5305
Practice Address - Fax:570-836-6564
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006129L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015583990002Medicaid
PA5404709OtherAETNA
PA814278OtherFIRST PRIORITY HEALTH
PA5404709OtherAETNA
PA814278OtherFIRST PRIORITY HEALTH