Healthcare Provider Details

I. General information

NPI: 1942904610
Provider Name (Legal Business Name): HERRERA CHIROPRACTIC & PAIN MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 W COMMONWEALTH AVE
FULLERTON CA
92833-3013
US

IV. Provider business mailing address

1841 W COMMONWEALTH AVE
FULLERTON CA
92833-3013
US

V. Phone/Fax

Practice location:
  • Phone: 951-961-6410
  • Fax:
Mailing address:
  • Phone: 951-961-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: JOHN HERRERA
Title or Position: DOCTOR
Credential: DC
Phone: 951-961-6410