Provider Demographics
NPI:1154390987
Name:HERBERT, JOSEPH JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:HERBERT
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 1:5019 VICTOR DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9624
Mailing Address - Country:US
Mailing Address - Phone:330-722-7709
Mailing Address - Fax:330-723-0850
Practice Address - Street 1:5019 VICTOR DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9624
Practice Address - Country:US
Practice Address - Phone:330-722-7709
Practice Address - Fax:330-723-0850
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2046146Medicaid
OHHE0857312Medicare ID - Type Unspecified
OH2046146Medicaid