Provider Demographics
NPI:1194015552
Name:ST. BERNARD FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:ST. BERNARD FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:ST. BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-889-5189
Mailing Address - Street 1:1400 BUFORD HWY
Mailing Address - Street 2:SUITE D-3
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8721
Mailing Address - Country:US
Mailing Address - Phone:678-889-5189
Mailing Address - Fax:678-889-8923
Practice Address - Street 1:1400 BUFORD HWY
Practice Address - Street 2:SUITE D-3
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8721
Practice Address - Country:US
Practice Address - Phone:678-889-5189
Practice Address - Fax:678-889-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008789111N00000X, 111NN0400X, 111NP0017X, 111NR0200X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty