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General NPI Number Information
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NPI Number | 1699880914
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Entity Type | Individual
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Provider Name | BRUCE FERNANDES DC
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 35 WINTER ST
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City | HYANNIS
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State | MA
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Zip | 02601-3827
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Country | US
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Telephone | 508-790-3863
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Fax | 508-790-3863
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Provider Business Mailing Address
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Address Line | 86 OLD COLONY DR
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City | MASHPEE
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State | MA
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Zip | 02649-2532
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Country | US
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Telephone | 508-477-6955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1291
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License Number State | MA
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