Provider Demographics
NPI:1497150130
Name:HERNANDEZ CHIROPRACTIC SAN MARCOS, INC.
Entity Type:Organization
Organization Name:HERNANDEZ CHIROPRACTIC SAN MARCOS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-591-4878
Mailing Address - Street 1:1125 LINDA VISTA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-3819
Mailing Address - Country:US
Mailing Address - Phone:760-591-4878
Mailing Address - Fax:
Practice Address - Street 1:1125 LINDA VISTA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-3819
Practice Address - Country:US
Practice Address - Phone:760-591-4878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28894Medicare PIN