MEDICARE: DR. YADIEL NIEVES HERNANDEZ DC

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	289904	KY

General Provider Information

NPI Number	:	1104688597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YADIEL NIEVES HERNANDEZ DC

Provider Business Mailing Address
First Line	:	3900 YORKTOWNE BLVD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-6008
Country	:	US
Telephone Number	:	787-234-3973
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 BISHOP LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-4558
Country	:	US
Telephone Number	:	502-956-3965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	01/30/2024

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