Provider Demographics
NPI:1578509790
Name:BERNARD, GREGORY WINTON (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WINTON
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 1:511 PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7037
Mailing Address - Country:US
Mailing Address - Phone:715-410-0706
Mailing Address - Fax:715-410-0706
Practice Address - Street 1:330 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011-5087
Practice Address - Country:US
Practice Address - Phone:715-410-0706
Practice Address - Fax:715-410-0706
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3147111N00000X
WI3021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000075947Medicare UPIN
MN350003706Medicare UPIN