Provider Demographics
NPI:1902617673
Name:FERNANDEZ, FERNANDO (DC)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
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 1:4170 TOWN CTR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5875
Mailing Address - Country:US
Mailing Address - Phone:407-857-6166
Mailing Address - Fax:
Practice Address - Street 1:4170 TOWN CTR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-5875
Practice Address - Country:US
Practice Address - Phone:407-857-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor