Provider Demographics
NPI:1811776446
Name:HERNANDEZ IRIZARRY, JOSE ALBERTO (DC)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALBERTO
Last Name:HERNANDEZ IRIZARRY
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 1:116 SUNNY DAY WAY
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-8597
Mailing Address - Country:US
Mailing Address - Phone:386-214-4558
Mailing Address - Fax:
Practice Address - Street 1:2940 MALLORY CIR STE 205
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-1818
Practice Address - Country:US
Practice Address - Phone:407-507-6976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor