Provider Demographics
NPI:1972807964
Name:HERZOG, CARRIE (DC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:HERZOG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 TANGIER ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2481
Mailing Address - Country:US
Mailing Address - Phone:561-543-2053
Mailing Address - Fax:
Practice Address - Street 1:7190 SW 87TH AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2507
Practice Address - Country:US
Practice Address - Phone:305-661-2299
Practice Address - Fax:305-661-0851
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7415111N00000X
FLPA9109740363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No111N00000XChiropractic ProvidersChiropractor