Basic Information
Provider Information
NPI: 1003142217
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERRINGTON
FirstName: DANIEL
MiddleName: BRANDON
NamePrefix: DR.
NameSuffix:  
Credential: D.C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1309 HIGHWAY 15 N STE C
Address2:  
City: LAUREL
State: MS
PostalCode: 394402652
CountryCode: US
TelephoneNumber: 6015184545
FaxNumber: 6015180029
Practice Location
Address1: 1309 HIGHWAY 15 N STE C
Address2:  
City: LAUREL
State: MS
PostalCode: 394402652
CountryCode: US
TelephoneNumber: 6015184545
FaxNumber: 6015180029
Other Information
ProviderEnumerationDate: 10/22/2009
LastUpdateDate: 10/22/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000X1150MSY Chiropractic ProvidersChiropractor 

No ID Information.


Home