Healthcare Provider Details

I. General information

NPI: 1487645057
Provider Name (Legal Business Name): JAMES FREDERIC HERMOE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 3RD AVE S
SAINT JAMES MN
56081-1709
US

IV. Provider business mailing address

610 3RD AVE S
SAINT JAMES MN
56081-1709
US

V. Phone/Fax

Practice location:
  • Phone: 507-375-4343
  • Fax:
Mailing address:
  • Phone: 507-375-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1446
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: