Provider Demographics
NPI:1013906726
Name:HERRIN, DEAN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:LEE
Last Name:HERRIN
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:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231-0022
Mailing Address - Country:US
Mailing Address - Phone:309-582-3326
Mailing Address - Fax:309-582-3326
Practice Address - Street 1:606 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-1808
Practice Address - Country:US
Practice Address - Phone:309-582-3326
Practice Address - Fax:309-582-3326
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350040641OtherRAILROAD MEDICARE
IL918090Medicare PIN