Healthcare Provider Details

I. General information

NPI: 1083653158
Provider Name (Legal Business Name): ROBERT J HERMANN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 E WASHINGTON ST SUITE 'F'
BLOOMINGTON IL
61704-4473
US

IV. Provider business mailing address

5 BENT TREE LN
TOWANDA IL
61776-7511
US

V. Phone/Fax

Practice location:
  • Phone: 309-663-2423
  • Fax: 309-662-0223
Mailing address:
  • Phone: 309-728-2621
  • Fax: 309-662-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number038005048
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: