Provider Demographics
NPI:1770625733
Name:HERFINDAHL, ASHLEY JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:JOHN
Last Name:HERFINDAHL
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 1:438 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3509
Mailing Address - Country:US
Mailing Address - Phone:619-295-3885
Mailing Address - Fax:619-295-3825
Practice Address - Street 1:438 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3509
Practice Address - Country:US
Practice Address - Phone:619-295-3885
Practice Address - Fax:619-295-3825
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27238Medicare ID - Type UnspecifiedMEDICARE