Provider Demographics
NPI:1316086796
Name:HERRERA, EDUARDO (L AC)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:HERRERA
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1302
Mailing Address - Country:US
Mailing Address - Phone:708-387-2058
Mailing Address - Fax:708-387-2138
Practice Address - Street 1:3504 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1302
Practice Address - Country:US
Practice Address - Phone:708-387-2058
Practice Address - Fax:708-387-2138
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist