Provider Demographics
NPI:1477956696
Name:FERNANDES, EDDIE (DC)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:
Last Name:FERNANDES
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 1:36 LAWRENCE THOMPSON BLIVD
Mailing Address - Street 2:
Mailing Address - City:GEORGE TOWN
Mailing Address - State:GRAND CAYMAN
Mailing Address - Zip Code:KY11204
Mailing Address - Country:KY
Mailing Address - Phone:345-943-8200
Mailing Address - Fax:
Practice Address - Street 1:36 LAWRENCE THOMPSON BLIVD
Practice Address - Street 2:
Practice Address - City:GEORGE TOWN
Practice Address - State:GRAND CAYMAN
Practice Address - Zip Code:KY11204
Practice Address - Country:KY
Practice Address - Phone:345-943-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30830OtherCHIROPRACTIC LICENCE