Provider Demographics
NPI:1811357841
Name:HERNANDEZ, ELISE MARIA (DC)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:MARIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3701 S COOPER ST
Mailing Address - Street 2:UNIT 185
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3445
Mailing Address - Country:US
Mailing Address - Phone:817-962-0182
Mailing Address - Fax:817-962-0128
Practice Address - Street 1:3701 S COOPER ST
Practice Address - Street 2:UNIT 185
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-3445
Practice Address - Country:US
Practice Address - Phone:817-962-0182
Practice Address - Fax:817-962-0128
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11634111N00000X
TX13150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor