Provider Demographics
NPI:1528182037
Name:BERNARD, LARRY DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DAVID
Last Name:BERNARD
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 1:205 BAYOU GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-1477
Mailing Address - Country:US
Mailing Address - Phone:985-868-0037
Mailing Address - Fax:985-223-4478
Practice Address - Street 1:205 BAYOU GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-1477
Practice Address - Country:US
Practice Address - Phone:985-868-0037
Practice Address - Fax:985-223-4478
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1958272Medicaid
LA1958272Medicaid
LA55954D698Medicare ID - Type Unspecified