Healthcare Provider Details

I. General information

NPI: 1215901566
Provider Name (Legal Business Name): MARTIN JOHN HERBKERSMAN I D.AC., MTOM, L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 BULL ST
COLUMBIA SC
29201-2508
US

IV. Provider business mailing address

1920 BULL ST
COLUMBIA SC
29201-2508
US

V. Phone/Fax

Practice location:
  • Phone: 803-806-8889
  • Fax: 803-806-8893
Mailing address:
  • Phone: 803-806-8889
  • Fax: 803-806-8893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number57
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number9018
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDA00193
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: