=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083019137
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERNARD CHIROPRACTIC & WELLNESS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2014
-----------------------------------------------------
Last Update Date | 10/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2304 9TH ST
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76301-4031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-969-9007
-----------------------------------------------------
Fax | 940-723-0807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2304 9TH ST
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76301-4031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-696-9007
-----------------------------------------------------
Fax | 940-723-0807
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. HOLLY MICHELLE MATUS
-----------------------------------------------------
Credential | C.A.
-----------------------------------------------------
Telephone | 940-696-9007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------