Provider Demographics
NPI:1275673808
Name:BERMUDEZ, GUILLERMO J (DC,)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:J
Last Name:BERMUDEZ
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 1:4900 SW GRIFFITH DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4649
Mailing Address - Country:US
Mailing Address - Phone:503-644-2225
Mailing Address - Fax:503-644-2226
Practice Address - Street 1:4900 SW GRIFFITH DR STE 110
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4649
Practice Address - Country:US
Practice Address - Phone:503-644-2225
Practice Address - Fax:503-644-2226
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3598111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician