Provider Demographics
NPI:1891787164
Name:HERGENROETHER, MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HERGENROETHER
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 1:5350 HOLLISTER AVE
Mailing Address - Street 2:A3
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2326
Mailing Address - Country:US
Mailing Address - Phone:805-681-7322
Mailing Address - Fax:805-681-5072
Practice Address - Street 1:5350 HOLLISTER AVE
Practice Address - Street 2:A3
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2326
Practice Address - Country:US
Practice Address - Phone:805-681-7322
Practice Address - Fax:805-681-5072
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0717880OtherBLUE SHIELD PIN
CADC07178800OtherBLUE CROSS PIN
CAT18498Medicare UPIN
CADC07178800OtherBLUE CROSS PIN