Provider Demographics
NPI:1851396352
Name:HERMANN, BRUCE D (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:D
Last Name:HERMANN
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 1:439 E OLD STATE ROAD 14
Mailing Address - Street 2:
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-8702
Mailing Address - Country:US
Mailing Address - Phone:574-946-6111
Mailing Address - Fax:574-946-6112
Practice Address - Street 1:439 E OLD STATE ROAD 14
Practice Address - Street 2:
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-8702
Practice Address - Country:US
Practice Address - Phone:574-946-6111
Practice Address - Fax:574-946-6112
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000388111N00000X
KY2930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000181411OtherANTHEM
IN670250Medicare ID - Type Unspecified
INOTH000Medicare UPIN