Provider Demographics
NPI:1952074296
Name:HERNANDEZ, YADIRA GUADALUPE (DC)
Entity Type:Individual
Prefix:DR
First Name:YADIRA
Middle Name:GUADALUPE
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 1:13343 DOVE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-4520
Mailing Address - Country:US
Mailing Address - Phone:214-470-1396
Mailing Address - Fax:
Practice Address - Street 1:504 N OAK ST STE 2
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-5005
Practice Address - Country:US
Practice Address - Phone:214-470-1396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor