Healthcare Provider Details

I. General information

NPI: 1063474443
Provider Name (Legal Business Name): DAVID ANDREW HERD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 NORTH MAIN STREET
GENEVA NY
14456-1604
US

IV. Provider business mailing address

1445 PORTLAND AVENUE SUITE 309
ROCHESTER NY
14621-3008
US

V. Phone/Fax

Practice location:
  • Phone: 315-789-2223
  • Fax: 585-730-7500
Mailing address:
  • Phone: 585-342-2638
  • Fax: 585-730-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX002460-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: