=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841593589
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID A. HERD, DC, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2010
-----------------------------------------------------
Last Update Date | 12/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 124 N MAIN ST
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14456-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-789-2223
-----------------------------------------------------
Fax | 315-789-0463
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124 N MAIN ST
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14456-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-789-2223
-----------------------------------------------------
Fax | 315-789-0463
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID A. HERD
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 315-789-2223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | X2460
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------