Provider Demographics
NPI:1467471151
Name:HERNLY, VIRGINIA L (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:L
Last Name:HERNLY
Suffix:
Gender:F
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 3RD AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4050
Mailing Address - Country:US
Mailing Address - Phone:650-347-4443
Mailing Address - Fax:650-347-5783
Practice Address - Street 1:205 E 3RD AVE STE 406
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4050
Practice Address - Country:US
Practice Address - Phone:650-347-4443
Practice Address - Fax:650-347-5783
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15946111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0159460Medicare ID - Type Unspecified