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General NPI Number Information
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NPI Number | 1912217738
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Entity Type | Organization
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Legal Business Name | HEBERT CHIROPRACTIC PC
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 400 N PARK STREET SUITE 13A
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City | BRECKENRIDGE
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State | CO
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Zip | 80424
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Country | US
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Telephone | 970-453-7809
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Fax | 970-453-0336
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Provider Business Mailing Address
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Address Line | PO BOX 8857
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City | BRECKENRIDGE
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State | CO
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Zip | 80424-9002
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Country | US
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Telephone | 970-453-7809
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Fax | 970-453-0336
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | STEPHEN PAUL HEBERT
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Credential | DC
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Telephone | 970-453-7809
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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 | 5026
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License Number State | CO
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