Healthcare Provider Details

I. General information

NPI: 1760706303
Provider Name (Legal Business Name): MARK S HERSCHBERGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 N IMPERIAL AVE
EL CENTRO CA
92243-2329
US

IV. Provider business mailing address

428 N IMPERIAL AVE
EL CENTRO CA
92243-2329
US

V. Phone/Fax

Practice location:
  • Phone: 760-353-3422
  • Fax: 760-353-9163
Mailing address:
  • Phone: 760-353-3422
  • Fax: 760-353-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 19832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: