Provider Demographics
NPI:1194227421
Name:HERRERA, CARLOS ANDRES
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ANDRES
Last Name:HERRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 CANARY CIR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5808
Mailing Address - Country:US
Mailing Address - Phone:850-305-5793
Mailing Address - Fax:
Practice Address - Street 1:1896 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7676
Practice Address - Country:US
Practice Address - Phone:789-289-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12400111N00000X
MS1408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor