1649237116 NPI number — HERNANDEZ CHIROPRACTIC INC

Table of content: TERESA MARIE LIEN LMP (NPI 1174641492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649237116 NPI number — HERNANDEZ CHIROPRACTIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERNANDEZ CHIROPRACTIC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649237116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 S STATE ROAD 7
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-4395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-792-4016
Provider Business Mailing Address Fax Number:
561-792-4162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 S STATE ROAD 7
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-4395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-792-4016
Provider Business Practice Location Address Fax Number:
561-792-4162
Provider Enumeration Date:
04/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-792-4016

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH0006799 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)