Provider Demographics
NPI:1902851991
Name:HERNDON, DORIE (DC)
Entity Type:Individual
Prefix:DR
First Name:DORIE
Middle Name:
Last Name:HERNDON
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 1:3005 REVERE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIGANTINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08203-1797
Mailing Address - Country:US
Mailing Address - Phone:609-266-5555
Mailing Address - Fax:609-266-5453
Practice Address - Street 1:3005 REVERE BLVD
Practice Address - Street 2:
Practice Address - City:BRIGANTINE
Practice Address - State:NJ
Practice Address - Zip Code:08203-1797
Practice Address - Country:US
Practice Address - Phone:609-266-5555
Practice Address - Fax:609-266-5453
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ457275STUMedicare PIN