Provider Demographics
NPI:1932263159
Name:DANIEL R. FERNANDEZ, D.C., P.A.
Entity Type:Organization
Organization Name:DANIEL R. FERNANDEZ, D.C., P.A.
Other - Org Name:US1 FAMILY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RODOLFO
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-246-1664
Mailing Address - Street 1:46 N HOMESTEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-7416
Mailing Address - Country:US
Mailing Address - Phone:305-246-1664
Mailing Address - Fax:305-248-9016
Practice Address - Street 1:46 N HOMESTEAD BLVD
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-7416
Practice Address - Country:US
Practice Address - Phone:305-246-1664
Practice Address - Fax:305-248-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6015Medicare ID - Type UnspecifiedEDI