Provider Demographics
NPI:1457476228
Name:FERNANDEZ, DOROTHY (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140924
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-0924
Mailing Address - Country:US
Mailing Address - Phone:718-608-5651
Mailing Address - Fax:
Practice Address - Street 1:1749 VICTORY BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3544
Practice Address - Country:US
Practice Address - Phone:718-608-5651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008911-1111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation