Healthcare Provider Details

I. General information

NPI: 1194015552
Provider Name (Legal Business Name): ST. BERNARD FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BUFORD HWY SUITE D-3
BUFORD GA
30518-8721
US

IV. Provider business mailing address

1400 BUFORD HWY SUITE D-3
BUFORD GA
30518-8721
US

V. Phone/Fax

Practice location:
  • Phone: 678-889-5189
  • Fax: 678-889-8923
Mailing address:
  • Phone: 678-889-5189
  • Fax: 678-889-8923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR008789
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCHIR008789
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberCHIR008789
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberCHIR008789
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHIR008789
License Number StateGA

VIII. Authorized Official

Name: DR. ANDREW J ST. BERNARD
Title or Position: CHIROPRACTOR/ OWNER
Credential: D.C.
Phone: 678-889-5189