Provider Demographics
NPI:1326045626
Name:HERESCO CHIROPRACTIC AND ASSOCIATES PC
Entity type:Organization
Organization Name:HERESCO CHIROPRACTIC AND ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:T
Authorized Official - Last Name:HERESCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-757-9933
Mailing Address - Street 1:408 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6308
Mailing Address - Country:US
Mailing Address - Phone:541-757-9933
Mailing Address - Fax:541-757-7713
Practice Address - Street 1:408 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6308
Practice Address - Country:US
Practice Address - Phone:541-757-9933
Practice Address - Fax:541-757-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-1620111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
104418Medicare ID - Type Unspecified