Provider Demographics
NPI:1750472478
Name:BERNAL, JESUS GERARDO (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:GERARDO
Last Name:BERNAL
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 CIRCULO MERCADO
Mailing Address - Street 2:
Mailing Address - City:RIO RICO
Mailing Address - State:AZ
Mailing Address - Zip Code:85648-6202
Mailing Address - Country:US
Mailing Address - Phone:520-377-2225
Mailing Address - Fax:520-377-9200
Practice Address - Street 1:1115 CIRCULO MERCADO
Practice Address - Street 2:
Practice Address - City:RIO RICO
Practice Address - State:AZ
Practice Address - Zip Code:85648-6202
Practice Address - Country:US
Practice Address - Phone:520-377-2225
Practice Address - Fax:520-377-9200
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ68308Medicare ID - Type Unspecified