MEDICARE: FERNANDEZ-WILLS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4584	OH

General Provider Information

NPI Number	:	1083169577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERNANDEZ-WILLS LLC

Provider Business Mailing Address
First Line	:	1741 W MAIN ST
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-2301
Country	:	US
Telephone Number	:	937-552-7364
Fax Number	:

Provider Business Practice Location Address
First Line	:	1741 W MAIN ST
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-2301
Country	:	US
Telephone Number	:	937-552-7364
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUAN FERNANDEZ-GOMEZ
Credential	:	D.C.
Telephone Number	:	570-239-6961

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	10/05/2016

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Directions to “FERNANDEZ-WILLS LLC ” Practice Location

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