Provider Demographics
NPI:1093896672
Name:FERNANDEZ, WILLIAM J (D C)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W BERRYHILL DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5835
Mailing Address - Country:US
Mailing Address - Phone:530-274-7764
Mailing Address - Fax:530-274-7544
Practice Address - Street 1:128 W BERRYHILL DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5835
Practice Address - Country:US
Practice Address - Phone:530-274-7764
Practice Address - Fax:530-274-7544
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0119020Medicare ID - Type Unspecified