Individual provider Active NPI

Carlos Andres Herrera

  • Chiropractor
  • Madison, MS
National Provider Identifier
1194227421
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1408 Issued in MS
Practice address
1896 Main St Ste a
Madison, MS 39110-7676
Phone
(789) 289-1114
NPI assigned
Mar 2, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH12400 FL
Chiropractor 111N00000X 1408 MS Primary

Addresses

Primary practice location

1896 Main St Ste a
Madison, MS 39110-7676

Mailing address

4643 Canary Cir
Crestview, FL 32539-5808
Phone (850) 305-5793

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201016001733 FL Practitioner - Chiropractic 1456771278 Reassigns benefits to 2 organizations
I20250729002491 MS Practitioner - Chiropractic 1456771278 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1896 Main St
Suite a
Madison, MS 39110-7676
Phone (769) 289-1114

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH12400FLMDChiropractor
1408MSMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Spine Family Chiropractic PLLC Chiropractor CurrentSince Jan 14, 2025 Accepting new patients
Seaside Spine LLC Chiropractor CurrentSince Sep 1, 2020 Accepting new patients
Seaside Spine Mary Esther LLC Chiropractor CurrentSince Feb 1, 2021 Accepting new patients

Locations

981 Highway 98 E
Ste 9
Destin, FL 32541
Phone (850) 460-2362

208 Mary Esther Blvd
Ste D
Mary Esther, FL 32569
Phone (850) 362-6182

1896 Main St
Ste A
Madison, MS 39110
Phone (601) 398-9886

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1194227421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4643 CANARY CIR",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325395808",
            "telephone_number": "850-305-5793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1896 MAIN ST STE A",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391107676",
            "telephone_number": "789-289-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERRERA",
        "first_name": "CARLOS",
        "middle_name": "ANDRES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-02",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH12400",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MS",
            "license": "1408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.