Healthcare Provider Details

I. General information

NPI: 1679500524
Provider Name (Legal Business Name): HERMAN TOBY WARREN DC CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 SUMMER HILL RD
NORTH AUGUSTA SC
29841
US

IV. Provider business mailing address

1519 SUMMER HILL RD
NORTH AUGUSTA SC
29841
US

V. Phone/Fax

Practice location:
  • Phone: 803-279-3922
  • Fax:
Mailing address:
  • Phone: 803-279-3922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0701
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number243
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: