Provider Demographics
NPI:1861426900
Name:HEBERT, DOUGLAS L (DC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:HEBERT
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:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:INDIAN RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49749-1028
Mailing Address - Country:US
Mailing Address - Phone:231-238-7337
Mailing Address - Fax:231-238-9177
Practice Address - Street 1:3722 S STRAITS HWY
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-1028
Practice Address - Country:US
Practice Address - Phone:231-238-7337
Practice Address - Fax:231-238-9177
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3084013Medicaid
O59870Medicare UPIN
MI3084013Medicaid