MEDICARE: NICHOLAS 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	CH13557	FL

General Provider Information

NPI Number	:	1477129765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS HERNANDEZ DC

Provider Business Mailing Address
First Line	:	1544 SW 150TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33194-2540
Country	:	US
Telephone Number	:	786-223-3748
Fax Number	:

Provider Business Practice Location Address
First Line	:	11285 SW 211TH ST
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-2211
Country	:	US
Telephone Number	:	786-414-1001
Fax Number	:

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

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	05/27/2021

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Directions to “ NICHOLAS HERNANDEZ DC” Practice Location

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