Healthcare Provider Details

I. General information

NPI: 1689762676
Provider Name (Legal Business Name): ROBERT HERMANN DC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 E WASHINGTON STREET STE F
BLOOMINGTON IL
61704
US

IV. Provider business mailing address

2415 E WASHINGTON STREET STE F
BLOOMINGTON IL
61704
US

V. Phone/Fax

Practice location:
  • Phone: 309-663-2423
  • Fax: 309-662-0223
Mailing address:
  • Phone: 309-663-2423
  • Fax: 309-662-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: ROBERT J HERMANN
Title or Position: PRESIDENT OWNER
Credential: DC DABCO
Phone: 309-663-2423