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General NPI Number Information
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NPI Number | 1417202078
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Entity Type | Organization
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Legal Business Name | DR. VIRGINIA HERNLY
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 205 E 3RD AVE STE 406
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City | SAN MATEO
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State | CA
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Zip | 94401-4050
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Country | US
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Telephone | 650-347-4443
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Fax | 650-347-5783
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Provider Business Mailing Address
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Address Line | 205 E 3RD AVE STE 406
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City | SAN MATEO
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State | CA
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Zip | 94401-4050
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Country | US
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Telephone | 650-347-4443
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Fax | 650-347-5783
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Authorized Official
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Title or Position | OWNER/CHIROPRACTIC
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Name | DR. VIRGINIA L HERNLY
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Credential | D.C.
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Telephone | 650-347-4443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC15946
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License Number State | CA
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