Healthcare Provider Details

I. General information

NPI: 1407521909
Provider Name (Legal Business Name): HERRON CHIROPRACTIC AND WELLNE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/23/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 CROSSING CIR STE A
TRAVERSE CITY MI
49684-7955
US

IV. Provider business mailing address

2506 CROSSING CIR STE A
TRAVERSE CITY MI
49684-7955
US

V. Phone/Fax

Practice location:
  • Phone: 231-421-3333
  • Fax: 231-421-3355
Mailing address:
  • Phone: 231-421-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON HERRON HERRON
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 231-218-0855