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General NPI Number Information
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NPI Number | 1194015552
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Entity Type | Organization
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Legal Business Name | ST. BERNARD FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 04/19/2011
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Provider Practice Location Address
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Address Line | 1400 BUFORD HWY SUITE D-3
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City | BUFORD
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State | GA
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Zip | 30518-8721
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Country | US
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Telephone | 678-889-5189
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Fax | 678-889-8923
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Provider Business Mailing Address
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Address Line | 1400 BUFORD HWY SUITE D-3
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City | BUFORD
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State | GA
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Zip | 30518-8721
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Country | US
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Telephone | 678-889-5189
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Fax | 678-889-8923
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Authorized Official
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Title or Position | CHIROPRACTOR/ OWNER
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Name | DR. ANDREW J ST. BERNARD
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Credential | D.C.
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Telephone | 678-889-5189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | CHIR008789
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number | CHIR008789
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 111NR0200X
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Taxonomy Name | Radiology Chiropractor
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License Number | CHIR008789
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CHIR008789
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR008789
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License Number State | GA
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