Provider Demographics
NPI:1013241678
Name:RICHARD J HERBOLD CHIROPRACTOR PC
Entity Type:Organization
Organization Name:RICHARD J HERBOLD CHIROPRACTOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-371-6431
Mailing Address - Street 1:402 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1119
Mailing Address - Country:US
Mailing Address - Phone:518-374-7555
Mailing Address - Fax:518-374-6898
Practice Address - Street 1:140 LAPP RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-6018
Practice Address - Country:US
Practice Address - Phone:518-371-6431
Practice Address - Fax:518-383-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0273-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02731-0OtherLICENSE NUMBER
NYJ100006352OtherPTAN