Provider Demographics
NPI:1386791523
Name:HERRES CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:HERRES CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:T
Authorized Official - Last Name:HERRES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-543-1123
Mailing Address - Street 1:7007 BURDEN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-9185
Mailing Address - Country:US
Mailing Address - Phone:509-543-1123
Mailing Address - Fax:509-543-6851
Practice Address - Street 1:7007 BURDEN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9185
Practice Address - Country:US
Practice Address - Phone:509-543-1123
Practice Address - Fax:509-543-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU40553Medicare UPIN