Provider Demographics
NPI:1154509537
Name:FERNANDES CHIROPRACTIC LTD.
Entity Type:Organization
Organization Name:FERNANDES CHIROPRACTIC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERNANDES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-669-6071
Mailing Address - Street 1:4093 W ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-9401
Mailing Address - Country:US
Mailing Address - Phone:847-669-6071
Mailing Address - Fax:847-669-6074
Practice Address - Street 1:4093 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9401
Practice Address - Country:US
Practice Address - Phone:847-669-6071
Practice Address - Fax:847-669-6074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209914OtherMEDICARE PTAN