Provider Demographics
NPI:1922066034
Name:HERNANDEZ, SANDRA E (DC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:E
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 1:125 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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55191OtherBLUE CROSS BLUE SHIELD
FL5804422OtherGHI
FL55191OtherBLUE CROSS BLUE SHIELD
FLU51787Medicare UPIN