Provider Demographics
NPI:1659783082
Name:HERNANDEZ, KRISTINE N (DC)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:N
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 LINDBERGH BLVD
Mailing Address - Street 2:110
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913
Mailing Address - Country:US
Mailing Address - Phone:787-225-3220
Mailing Address - Fax:239-334-9358
Practice Address - Street 1:11300 LINDBERGH BLVD
Practice Address - Street 2:110
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8827
Practice Address - Country:US
Practice Address - Phone:239-334-9355
Practice Address - Fax:239-334-9358
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor