Provider Demographics
NPI:1316134547
Name:HERZBERG CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:HERZBERG CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:HERZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-542-1404
Mailing Address - Street 1:112 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-1601
Mailing Address - Country:US
Mailing Address - Phone:712-542-1404
Mailing Address - Fax:712-542-2815
Practice Address - Street 1:112 N 16TH ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1601
Practice Address - Country:US
Practice Address - Phone:712-542-1404
Practice Address - Fax:712-542-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1316134547Medicaid
IA1316134547Medicaid