Provider Demographics
NPI:1750653010
Name:BERNSTEIN CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:BERNSTEIN CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-423-3344
Mailing Address - Street 1:10481 SAINT CHARLES ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-1836
Mailing Address - Country:US
Mailing Address - Phone:314-423-3344
Mailing Address - Fax:314-423-8934
Practice Address - Street 1:10481 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-1836
Practice Address - Country:US
Practice Address - Phone:314-423-3344
Practice Address - Fax:314-423-8934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE005859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty