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General NPI Number Information
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NPI Number | 1366479925
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Entity Type | Organization
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Legal Business Name | HERSON CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 31781 CAMINO CAPISTRANO STE 303
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3227
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Country | US
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Telephone | 949-661-2511
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Fax | 949-661-2440
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Provider Business Mailing Address
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Address Line | 31781 CAMINO CAPISTRANO STE 303
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3227
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Country | US
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Telephone | 949-661-2511
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Fax | 949-661-2440
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Authorized Official
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Title or Position | PRESIDENT/CHIROPRACTOR
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Name | DR. KEVIN MARC HERSON
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Credential | D.C.
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Telephone | 949-661-2511
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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 | DC28895
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License Number State | CA
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