MEDICARE: DR. GILBERT NMN HERNANDEZ JR. D.C.

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	DC29165	CA

General Provider Information

NPI Number	:	1861551277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GILBERT NMN HERNANDEZ JR. D.C.

Provider Business Mailing Address
First Line	:	22997 ORANGEWOOD CT
Second Line	:
City	:	GRAND TERRACE
State	:	CA
Zip	:	92313-5576
Country	:	US
Telephone Number	:	909-422-1060
Fax Number	:	909-370-0564

Provider Business Practice Location Address
First Line	:	22448 BARTON RD
Second Line	:
City	:	GRAND TERRACE
State	:	CA
Zip	:	92313-5009
Country	:	US
Telephone Number	:	909-370-1564
Fax Number	:	909-370-0564

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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