Provider Demographics
NPI:1851370571
Name:BERNER, GARY T (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:T
Last Name:BERNER
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 1:5850 BOYMEL DR
Mailing Address - Street 2:UNIT #2
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-8529
Mailing Address - Country:US
Mailing Address - Phone:513-870-9559
Mailing Address - Fax:513-870-9593
Practice Address - Street 1:5850 BOYMEL DR
Practice Address - Street 2:UNIT #2
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-8529
Practice Address - Country:US
Practice Address - Phone:513-870-9559
Practice Address - Fax:513-870-9593
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0898891Medicaid
OH311358253-00OtherGRP OHIO BWC NUMBER
OH0610032Medicare PIN
OHT48729Medicare UPIN