Provider Demographics
NPI:1285961979
Name:FERNANDEZ, JACOB JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JOHN
Last Name:FERNANDEZ
Suffix:
Gender:M
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:PO BOX 821099
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-1099
Mailing Address - Country:US
Mailing Address - Phone:817-498-7788
Mailing Address - Fax:817-849-1011
Practice Address - Street 1:6709 MEADOW CREST DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6669
Practice Address - Country:US
Practice Address - Phone:817-498-7788
Practice Address - Fax:817-849-1011
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor