Healthcare Provider Details

I. General information

NPI: 1659333524
Provider Name (Legal Business Name): BERNARD D SIRIOS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N WASHINGTON ST
SALEM MO
65560-1268
US

IV. Provider business mailing address

504 N WASHINGTON ST
SALEM MO
65560-1268
US

V. Phone/Fax

Practice location:
  • Phone: 573-729-5321
  • Fax: 573-729-1010
Mailing address:
  • Phone: 573-729-5321
  • Fax: 573-729-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number005551
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: