Provider Demographics
NPI:1649237116
Name:HERNANDEZ CHIROPRACTIC INC
Entity Type:Organization
Organization Name:HERNANDEZ CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-792-4016
Mailing Address - Street 1:125 S STATE ROAD 7
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4395
Mailing Address - Country:US
Mailing Address - Phone:561-792-4016
Mailing Address - Fax:561-792-4162
Practice Address - Street 1:125 S STATE ROAD 7
Practice Address - Street 2:SUITE 103
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4395
Practice Address - Country:US
Practice Address - Phone:561-792-4016
Practice Address - Fax:561-792-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7031Medicare PIN