Provider Demographics
NPI:1407853914
Name:HERESCO, FRANK THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:THOMAS
Last Name:HERESCO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-1620111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR008172Medicaid
R104419Medicare PIN
T60468Medicare UPIN