Provider Demographics
NPI:1235105164
Name:FERNANDES, PAMELA A (DC)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:A
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4093 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
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532030OtherBLUECROSSBLUESHIELDPROV.#
IL04532030OtherBLUECROSSBLUESHIELDPROV.#