Provider Demographics
NPI:1659515476
Name:BERNAL GALLO, CESAR ALDO (DC)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:ALDO
Last Name:BERNAL GALLO
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 1:330 MEADOW AVE N
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5721
Mailing Address - Country:US
Mailing Address - Phone:408-569-6473
Mailing Address - Fax:206-762-6600
Practice Address - Street 1:10223 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-1433
Practice Address - Country:US
Practice Address - Phone:206-764-9600
Practice Address - Fax:206-762-6600
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60159579111N00000X
CA31234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor