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General NPI Number Information
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NPI Number | 1013919869
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Entity Type | Individual
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Provider Name | RICHARD J HERBOLD D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 01/20/2009
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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 |
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Provider Business Mailing Address
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Address Line | 45 GEISER RD
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City | WYNANTSKILL
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State | NY
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Zip | 12198-2502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 02731-0
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License Number State | NY
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