Provider Demographics
NPI:1437148335
Name:HERNANDEZ, JAVIER SAMUEL (DC)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:SAMUEL
Last Name:HERNANDEZ
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 1:7105 CENTURY PLANT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1356
Mailing Address - Country:US
Mailing Address - Phone:915-307-1260
Mailing Address - Fax:915-591-5567
Practice Address - Street 1:7420 REMCON CIR
Practice Address - Street 2:STE. C-3
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3529
Practice Address - Country:US
Practice Address - Phone:915-587-4600
Practice Address - Fax:915-581-6324
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC9979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1682OtherNM DC LICENSE
TXDC9979OtherSTATE LISCENCE NUMBER