MEDICARE: DR. JOSE HERRERA DC

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	DC27442	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952453672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE HERRERA DC

Provider Business Mailing Address
First Line	:	1095 NORTH D STREET
Second Line	:	SUITE 100
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92410
Country	:	US
Telephone Number	:	909-888-7649
Fax Number	:	909-888-1955

Provider Business Practice Location Address
First Line	:	1095 NORTH D STREET
Second Line	:	SUITE 100
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92410
Country	:	US
Telephone Number	:	909-888-7649
Fax Number	:	909-888-1955

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	12/02/2010

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