Provider Demographics
NPI:1134530355
Name:BERNS, ANDREW S (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:BERNS
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 1:4004 CAMPBELL STREET
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-1772
Mailing Address - Country:US
Mailing Address - Phone:219-465-1140
Mailing Address - Fax:219-465-0903
Practice Address - Street 1:4004 CAMPBELL STREET
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-1772
Practice Address - Country:US
Practice Address - Phone:219-465-1140
Practice Address - Fax:219-465-0903
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002772A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN08002772AOtherLICENSE