Provider Demographics
NPI:1336651389
Name:BERNAL, STEVEN PAUL (DC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:PAUL
Last Name:BERNAL
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 1:50 WHITLOCK PL SW
Mailing Address - Street 2:STE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3164
Mailing Address - Country:US
Mailing Address - Phone:229-382-3210
Mailing Address - Fax:
Practice Address - Street 1:50 WHITLOCK PL SW
Practice Address - Street 2:STE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3164
Practice Address - Country:US
Practice Address - Phone:229-382-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009963111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor