Provider Demographics
NPI:1437142718
Name:BERNHARD, SCOTT (D C)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:BERNHARD
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 1:10895 SW TIGARD ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4132
Mailing Address - Country:US
Mailing Address - Phone:503-598-9302
Mailing Address - Fax:503-598-0755
Practice Address - Street 1:10895 SW TIGARD ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4132
Practice Address - Country:US
Practice Address - Phone:503-598-9302
Practice Address - Fax:503-598-0755
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2015-01-04
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
OR27-1592111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic