Provider Demographics
NPI:1295715621
Name:HERMAN, SCOTT J (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:HERMAN
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 1:4400 W SAMPLE RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3470
Mailing Address - Country:US
Mailing Address - Phone:954-917-4343
Mailing Address - Fax:954-917-7977
Practice Address - Street 1:4400 W SAMPLE RD
Practice Address - Street 2:STE 114
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073
Practice Address - Country:US
Practice Address - Phone:954-917-4343
Practice Address - Fax:954-917-7977
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381142500Medicaid
FL55658ZMedicare PIN
U71650Medicare UPIN