Provider Demographics
NPI:1154326981
Name:FERNANDES, JAMES (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FERNANDES
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 1:910 MOUNT HOMER RD
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6258
Mailing Address - Country:US
Mailing Address - Phone:352-357-8615
Mailing Address - Fax:357-357-5873
Practice Address - Street 1:910 MOUNT HOMER RD
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6258
Practice Address - Country:US
Practice Address - Phone:352-357-8615
Practice Address - Fax:357-357-5873
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55269ZMedicare PIN
FLU56786Medicare UPIN