Provider Demographics
NPI:1467922401
Name:HERNANDEZ, JOSE JR (DC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
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 1:7205 VISTA DR STE 104
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-9360
Mailing Address - Country:US
Mailing Address - Phone:515-225-9200
Mailing Address - Fax:
Practice Address - Street 1:7205 VISTA DR STE 104
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-9360
Practice Address - Country:US
Practice Address - Phone:515-225-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor