Provider Demographics
NPI:1790997377
Name:HERNANDEZ, JORGE J (DC)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:J
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 BURNHAVEN DR STE 180
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-5610
Mailing Address - Country:US
Mailing Address - Phone:952-895-0660
Mailing Address - Fax:952-895-9408
Practice Address - Street 1:14500 BURNHAVEN DR STE 180
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-5610
Practice Address - Country:US
Practice Address - Phone:952-895-0660
Practice Address - Fax:952-895-9408
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor