Provider Demographics
NPI:1477570042
Name:FERNANDEZ, DANIEL RODOLFO (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RODOLFO
Last Name:FERNANDEZ
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 1:46 N HOMESTEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-7416
Mailing Address - Country:US
Mailing Address - Phone:305-246-1664
Mailing Address - Fax:305-248-9016
Practice Address - Street 1:46 N HOMESTEAD BLVD
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-7416
Practice Address - Country:US
Practice Address - Phone:305-246-1664
Practice Address - Fax:305-248-9016
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-8207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381449100Medicaid
FL70252OtherBLUE CROSS BLUE SHEILD
FL3974097OtherCIGNA
FL90-0063585OtherFIRST HEALTH
FLU88751Medicare UPIN
FL70252AMedicare ID - Type UnspecifiedMEDICARE