Provider Demographics
NPI:1215901566
Name:HERBKERSMAN, MARTIN JOHN I (DAC, MTOM, LAC)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOHN
Last Name:HERBKERSMAN
Suffix:I
Gender:M
Credentials:DAC, MTOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 BULL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2508
Mailing Address - Country:US
Mailing Address - Phone:803-806-8889
Mailing Address - Fax:803-806-8893
Practice Address - Street 1:1920 BULL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2508
Practice Address - Country:US
Practice Address - Phone:803-806-8889
Practice Address - Fax:803-806-8893
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC57171100000X
CA9018171100000X
RIDA00193171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist