Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 27-1592 | OR |
NPI | 1437142718 |
---|---|
Provider Name | Dr. Scott Bernhard |
First Address | Tigard, OR 97223-4132 |
Second Address | Tigard, OR 97223-4132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 04/01/2015 |