MEDICARE: GREGORY W BERNARD DC PA

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

General Provider Information

NPI Number	:	1245617687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY W BERNARD DC PA

Provider Business Mailing Address
First Line	:	511 PRAIRIE LN
Second Line	:
City	:	HUDSON
State	:	WI
Zip	:	54016-7037
Country	:	US
Telephone Number	:	715-410-0706
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 WEST MAIN STREET
Second Line	:
City	:	ELLSWORTH
State	:	WI
Zip	:	54011-5087
Country	:	US
Telephone Number	:	715-410-0706
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GREGORY BERNARD
Credential	:
Telephone Number	:	715-410-0706

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	05/06/2015

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