Provider Demographics
NPI:1073583449
Name:COOMES, BERNARD JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:JOHN
Last Name:COOMES
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 1:6067 N SHORT MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TN
Mailing Address - Zip Code:37095-9255
Mailing Address - Country:US
Mailing Address - Phone:615-563-4443
Mailing Address - Fax:615-563-4550
Practice Address - Street 1:313 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1144
Practice Address - Country:US
Practice Address - Phone:615-563-4443
Practice Address - Fax:615-563-4550
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN226111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3671902Medicare ID - Type Unspecified
TNT74473Medicare UPIN