MEDICARE: BERNEATHY CHIROPRACTIC OFFICE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC11853	CA

General Provider Information

NPI Number	:	1184788168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNEATHY CHIROPRACTIC OFFICE, INC

Provider Business Mailing Address
First Line	:	1707 GRAND AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4469
Country	:	US
Telephone Number	:	858-483-2400
Fax Number	:	858-483-2402

Provider Business Practice Location Address
First Line	:	1707 GRAND AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4469
Country	:	US
Telephone Number	:	858-483-2400
Fax Number	:	858-483-2402

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JERRY BERNEATHY
Credential	:	D.C.
Telephone Number	:	858-483-2400

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	08/22/2020

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