Provider Demographics
NPI:1891912903
Name:O'BRIEN, BERNARD PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:PAUL
Last Name:O'BRIEN
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 1:101 W BURNSVILLE PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2571
Mailing Address - Country:US
Mailing Address - Phone:952-224-9501
Mailing Address - Fax:952-224-9503
Practice Address - Street 1:101 W BURNSVILLE PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2571
Practice Address - Country:US
Practice Address - Phone:952-224-9501
Practice Address - Fax:952-224-9503
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN64B05OBOtherBCBS PROVIDER NUMBER