Healthcare Provider Details

I. General information

NPI: 1851396352
Provider Name (Legal Business Name): BRUCE D HERMANN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 E OLD STATE ROAD 14
WINAMAC IN
46996-8702
US

IV. Provider business mailing address

439 E OLD STATE ROAD 14
WINAMAC IN
46996-8702
US

V. Phone/Fax

Practice location:
  • Phone: 574-946-6111
  • Fax: 574-946-6112
Mailing address:
  • Phone: 574-946-6111
  • Fax: 574-946-6112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08000388
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2930
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: