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NPI Code Detail

MEDICARE: DR. RONALD G HERNANDEZ JR. DC

MEDICARE: DR. RONALD G HERNANDEZ JR. 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
1111N00000XChiropractor038.011413IL

General Provider Information

NPI Number : 1538393020
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD G HERNANDEZ JR. DC
Provider Business Mailing Address
First Line : 116 S. ILLINOIS AVE
Second Line :
City : VILLA PARK
State : IL
Zip : 60181
Country : US
Telephone Number : 773-269-9908
Fax Number :
Provider Business Practice Location Address
First Line : 1388 BUSCH PKWY
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-4505
Country : US
Telephone Number : 773-269-9908
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2009
Last Update Date : 08/20/2009

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