Provider Demographics
NPI:1730225491
Name:HERD, JACK D (DC)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:D
Last Name:HERD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4531
Mailing Address - Country:US
Mailing Address - Phone:717-737-1681
Mailing Address - Fax:717-731-1648
Practice Address - Street 1:2704 MARKET STREET
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4531
Practice Address - Country:US
Practice Address - Phone:717-737-1681
Practice Address - Fax:717-731-1648
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA001119L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1438356001OtherCIGNA PROV #S HERD
BSPBU5R84005OtherELECTRONIC BILLING
001119LOtherLICENSE NUMBERS HERD
2512627OtherAETNA PROV #S CLINIC
1704734001OtherCIGNA PROV #S CARVER
CALORADOtherASHLINK
5751845001OtherCIGNA PROV #S DINCHER
JH018019OtherASHLINK
MEDICAREPRJ15T8001OtherELECTRONIC BILLING
JH018019OtherASHLINK
5751845001OtherCIGNA PROV #S DINCHER
658218KPKMedicare ID - Type Unspecified& BLUE SHIELD CARVER
115888KPKMedicare ID - Type Unspecified& BLUE SHIELD HERD
010100Medicare Oscar/Certification
1438356001OtherCIGNA PROV #S HERD