Healthcare Provider Details

I. General information

NPI: 1952471955
Provider Name (Legal Business Name): RICHARD WILLIAM BERNSTEIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11611 SAN VICENTE BLVD SUITE 106A
LOS ANGELES CA
90049-5106
US

IV. Provider business mailing address

11611 SAN VICENTE BLVD SUITE 106A
LOS ANGELES CA
90049-5106
US

V. Phone/Fax

Practice location:
  • Phone: 310-780-4113
  • Fax:
Mailing address:
  • Phone: 310-780-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC16265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: