Provider Demographics
NPI:1841280591
Name:HERALD, JAMES MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:HERALD
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 1:808 CALDWELL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-1571
Mailing Address - Country:US
Mailing Address - Phone:814-736-9897
Mailing Address - Fax:814-736-9880
Practice Address - Street 1:808 CALDWELL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTAGE
Practice Address - State:PA
Practice Address - Zip Code:15946-1571
Practice Address - Country:US
Practice Address - Phone:814-736-9897
Practice Address - Fax:814-736-9880
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006906R111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01640317Medicaid
PAU11900Medicare UPIN
PA068525Medicare ID - Type Unspecified