Provider Demographics
NPI:1144213570
Name:BERNARD CHIROPRACTIC & WELLNESS PA
Entity Type:Organization
Organization Name:BERNARD CHIROPRACTIC & WELLNESS PA
Other - Org Name:BRIAN B BERNARD DC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-696-9007
Mailing Address - Street 1:2304 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4031
Mailing Address - Country:US
Mailing Address - Phone:940-696-9007
Mailing Address - Fax:940-696-9007
Practice Address - Street 1:2304 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4031
Practice Address - Country:US
Practice Address - Phone:940-696-9007
Practice Address - Fax:940-696-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165670101Medicaid
TX8R7450OtherBCBS TX
TX00339YMedicare ID - Type Unspecified
TX8R7450OtherBCBS TX