Provider Demographics
NPI:1548802333
Name:HERNANDEZ, ROBERT DYLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DYLAN
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:DYLAN
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1709 E TREMAINE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-8145
Mailing Address - Country:US
Mailing Address - Phone:702-277-0578
Mailing Address - Fax:
Practice Address - Street 1:4435 S RURAL RD STE 4
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7059
Practice Address - Country:US
Practice Address - Phone:480-491-7241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-13
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor