Provider Demographics
NPI:1942390380
Name:HERTING, DOUGLAS SCOTT (DOCTOR OF CHIRO)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:SCOTT
Last Name:HERTING
Suffix:
Gender:M
Credentials:DOCTOR OF CHIRO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445-1368
Mailing Address - Country:US
Mailing Address - Phone:707-561-2369
Mailing Address - Fax:707-400-5998
Practice Address - Street 1:39031 OCEAN DR STE 2
Practice Address - Street 2:
Practice Address - City:GUALALA
Practice Address - State:CA
Practice Address - Zip Code:95445-8434
Practice Address - Country:US
Practice Address - Phone:707-561-2369
Practice Address - Fax:707-400-5998
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0230190Medicare ID - Type Unspecified