Provider Demographics
NPI:1912217738
Name:HEBERT CHIROPRACTIC PC
Entity Type:Organization
Organization Name:HEBERT CHIROPRACTIC PC
Other - Org Name:ALLIED CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-453-7809
Mailing Address - Street 1:PO BOX 8857
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-9002
Mailing Address - Country:US
Mailing Address - Phone:970-453-7809
Mailing Address - Fax:970-453-0336
Practice Address - Street 1:400 N PARK STREET
Practice Address - Street 2:SUITE 13A
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424
Practice Address - Country:US
Practice Address - Phone:970-453-7809
Practice Address - Fax:970-453-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC439528Medicare UPIN