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General NPI Number Information
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NPI Number | 1033494588
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Entity Type | Organization
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Legal Business Name | SOUTH MOUNTAIN CHIROPRACTIC
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 1450 W. GUADALUPE RD #120
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City | GILBERT
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State | AZ
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Zip | 85233
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Country | US
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Telephone | 480-926-7800
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Fax | 480-926-2260
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Provider Business Mailing Address
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Address Line | 5505 W CHANDLER BLVD
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City | CHANDLER
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State | AZ
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Zip | 85226-3683
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Country | US
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Telephone | 480-759-8566
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Fax | 480-704-2448
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONALD J BERNARD
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Credential | DC
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Telephone | 480-759-8566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5458
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License Number State | AZ
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