Provider Demographics
NPI:1477666022
Name:HERNANDEZ, GUILLERMO ELOY (DC)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:ELOY
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 1:11935 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6729
Mailing Address - Country:US
Mailing Address - Phone:314-432-0005
Mailing Address - Fax:314-432-5899
Practice Address - Street 1:11935 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6729
Practice Address - Country:US
Practice Address - Phone:314-432-0005
Practice Address - Fax:314-432-5899
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO44-00555OtherUNITED HEALTHCARE
MO5327463OtherAETNA
MO7834OtherBLUECROSS/BLUESHIELD
MO113081OtherGHP
MO183078OtherHEALTH LINK
MOT43400Medicare UPIN