Provider Demographics
NPI:1861629644
Name:FERNANDEZ CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:FERNANDEZ CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:323-203-1800
Mailing Address - Street 1:12526 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3409
Mailing Address - Country:US
Mailing Address - Phone:818-985-2559
Mailing Address - Fax:818-985-4459
Practice Address - Street 1:12526 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3409
Practice Address - Country:US
Practice Address - Phone:818-985-2559
Practice Address - Fax:818-985-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-27059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty