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General NPI Number Information
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NPI Number | 1356494926
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Entity Type | Individual
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Provider Name | THOMAS THEODORE HERCHAKOWSKI D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 59 AVENUE OF THE CMN SUITE 201
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4806
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Country | US
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Telephone | 732-542-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 69 HARVARD RD
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City | FAIR HAVEN
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State | NJ
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Zip | 07704-3103
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Country | US
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Telephone | 732-747-3559
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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 | 38MC00639400
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License Number State | NJ
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