Provider Demographics
NPI:1750427787
Name:FERNANDEZ, MIGUEL A (DC)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GORHAM ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2575
Mailing Address - Country:US
Mailing Address - Phone:978-452-4223
Mailing Address - Fax:978-452-1511
Practice Address - Street 1:30 GORHAM ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2575
Practice Address - Country:US
Practice Address - Phone:978-452-4223
Practice Address - Fax:978-452-1511
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2221111N00000X
NY008644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA464923OtherTUFTS HEALTH PLAN
MA97437001OtherNETWORK HEALTH
MAY36592OtherBCBS OF MASSACHUSETTS
MA0027881OtherNEIGHBORHOOD HEALTH PLAN
MA1601091Medicaid
MA2554325OtherAETNA HEALTH PLAN
MA1601091Medicaid