Provider Demographics
NPI:1699835561
Name:FERNANDEZ, DENISE (DC)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:FERNANDEZ
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 1:15 DANBURY RD
Mailing Address - Street 2:2B
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4067
Mailing Address - Country:US
Mailing Address - Phone:203-431-8340
Mailing Address - Fax:203-438-9058
Practice Address - Street 1:15 DANBURY RD
Practice Address - Street 2:2B
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4067
Practice Address - Country:US
Practice Address - Phone:203-431-8340
Practice Address - Fax:203-438-9058
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000697CT01111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT05000697CT01OtherBLUE CROSS
CTPR61729780001OtherCIGNA
CTPR61729780001OtherCIGNA