Provider Demographics
NPI:1770619223
Name:BAYARD, BERNIE (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:BERNIE
Middle Name:
Last Name:BAYARD
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 NW GLISAN ST
Mailing Address - Street 2:STE C
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209
Mailing Address - Country:US
Mailing Address - Phone:503-288-9793
Mailing Address - Fax:
Practice Address - Street 1:1238 NW GLISAN ST
Practice Address - Street 2:STE C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3016
Practice Address - Country:US
Practice Address - Phone:503-288-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00102171100000X
OR0731175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath