Healthcare Provider Details

I. General information

NPI: 1649347493
Provider Name (Legal Business Name): MICHAEL D HERMANN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 EAST 10TH AVE.
VANCOUVER B.C.
V5T 2A2
CA

IV. Provider business mailing address

453 EAST 10TH AVE.
VANCOUVER B.C.
V5T 2A2
CA

V. Phone/Fax

Practice location:
  • Phone: 778-839-1014
  • Fax:
Mailing address:
  • Phone: 778-839-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC30160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: