1083653158 NPI number — DR. ROBERT J HERMANN D.C.

Table of content: DR. ROBERT J HERMANN D.C. (NPI 1083653158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083653158 NPI number — DR. ROBERT J HERMANN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERMANN
Provider First Name:
ROBERT
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083653158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 BENT TREE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWANDA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61776-7511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-728-2621
Provider Business Mailing Address Fax Number:
309-662-0223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2415 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 'F'
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61704-4473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-663-2423
Provider Business Practice Location Address Fax Number:
309-662-0223
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NX0800X , with the licence number:  038005048 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001213 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 9900H . This is a "CATERPILLAR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0573 2056 . This is a "BLUE CROSS BLUESHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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