Healthcare Provider Details

I. General information

NPI: 1235105164
Provider Name (Legal Business Name): PAMELA A FERNANDES DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4093 W ALGONQUIN RD.
ALGONQUIN IL
60102-9401
US

IV. Provider business mailing address

4093 W ALGONQUIN RD
ALGONQUIN IL
60102-9401
US

V. Phone/Fax

Practice location:
  • Phone: 847-669-6071
  • Fax: 847-669-6074
Mailing address:
  • Phone: 847-669-6071
  • Fax: 847-669-6074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-006334
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: