MEDICARE: HERFERT CHIROPRACTIC CENTER P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301004733	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P95560	OTHER	MI	WORK COMP
2	950F35280	OTHER	MI	BLUE CROSS

General Provider Information

NPI Number	:	1043390768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERFERT CHIROPRACTIC CENTER P.C.

Provider Business Mailing Address
First Line	:	2506 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-3817
Country	:	US
Telephone Number	:	248-853-7246
Fax Number	:	248-852-1815

Provider Business Practice Location Address
First Line	:	2506 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-3817
Country	:	US
Telephone Number	:	248-853-7246
Fax Number	:	248-852-1815

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERIC B HERFERT
Credential	:	DC
Telephone Number	:	248-853-7246

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	11/30/2011

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