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General NPI Number Information
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NPI Number | 1013241678
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Entity Type | Organization
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Legal Business Name | RICHARD J HERBOLD CHIROPRACTOR PC
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 140 LAPP RD
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City | CLIFTON PARK
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State | NY
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Zip | 12065-6018
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Country | US
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Telephone | 518-371-6431
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Fax | 518-383-5245
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Provider Business Mailing Address
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Address Line | 402 UNION ST
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City | SCHENECTADY
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State | NY
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Zip | 12305-1119
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Country | US
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Telephone | 518-374-7555
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Fax | 518-374-6898
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD J HERBOLD
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Credential | D.C.
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Telephone | 518-371-6431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0273-1
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License Number State | NY
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