Provider Demographics
NPI:1295854552
Name:BERND, MATTHEW GARRETT (D C)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GARRETT
Last Name:BERND
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-5243
Mailing Address - Country:US
Mailing Address - Phone:707-544-6975
Mailing Address - Fax:707-544-5042
Practice Address - Street 1:3651 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-5243
Practice Address - Country:US
Practice Address - Phone:707-544-6975
Practice Address - Fax:707-544-5042
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25657111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology