MEDICARE: DR. ASPEN BRAVO HERNANDES 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	2213	NE
2	111N00000X	Chiropractor	2025005526	MO

General Provider Information

NPI Number	:	1124995048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASPEN BRAVO HERNANDES DC

Provider Business Mailing Address
First Line	:	3231 W SEXTON ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-1298
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3422 S GLENSTONE AVE UNIT H3
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-4412
Country	:	US
Telephone Number	:	417-216-6191
Fax Number	:

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

Provider Enumeration Date	:	10/23/2025
Last Update Date	:	10/23/2025

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