Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038005048 | IL |
NPI | 1083653158 |
---|---|
Provider Name | Dr. Robert J Hermann |
First Address | Towanda, IL 61776-7511 |
Second Address | Bloomington, IL 61704-4473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 05/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001213 | HEALTH ALLIANCE (01) | IL |
0573 2056 | BLUE CROSS BLUESHIELD (01) | IL |
9900H | CATERPILLAR (01) | IL |
T38109 | (02) | IL |