Provider Demographics
NPI:1457691834
Name:HERCEG CHIROPRACTIC AND WELLNESS CENTER INC.
Entity Type:Organization
Organization Name:HERCEG CHIROPRACTIC AND WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:HERCEG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-563-4383
Mailing Address - Street 1:1102 CORSHAM CIRCLE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312
Mailing Address - Country:US
Mailing Address - Phone:740-632-1497
Mailing Address - Fax:
Practice Address - Street 1:3570 EXECUTIVE DR STE 211
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8712
Practice Address - Country:US
Practice Address - Phone:330-563-4383
Practice Address - Fax:330-563-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty