Healthcare Provider Details

I. General information

NPI: 1891794541
Provider Name (Legal Business Name): PAUL HERMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9469 SHERIDAN ST
COOPER CITY FL
33024-8561
US

IV. Provider business mailing address

9469 SHERIDAN ST
COOPER CITY FL
33024-8561
US

V. Phone/Fax

Practice location:
  • Phone: 954-432-5775
  • Fax: 954-432-2525
Mailing address:
  • Phone: 954-432-5775
  • Fax: 954-432-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: