Provider Demographics
NPI:1942290614
Name:HERD, PHILLIP MCCLOY (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:MCCLOY
Last Name:HERD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:PHILLIP
Other - Middle Name:MCCLOY
Other - Last Name:HERD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:263 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1648
Mailing Address - Country:US
Mailing Address - Phone:724-547-4373
Mailing Address - Fax:724-547-2982
Practice Address - Street 1:263 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1648
Practice Address - Country:US
Practice Address - Phone:724-547-4373
Practice Address - Fax:724-547-2982
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001397L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
115886OtherHIGHMARK BLUE CROSS
482711OtherAETNA
115886Medicare ID - Type Unspecified