Provider Demographics
NPI:1033494588
Name:SOUTH MOUNTAIN CHIROPRACTIC
Entity type:Organization
Organization Name:SOUTH MOUNTAIN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-759-8566
Mailing Address - Street 1:5505 W CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3683
Mailing Address - Country:US
Mailing Address - Phone:480-759-8566
Mailing Address - Fax:480-704-2448
Practice Address - Street 1:1450 W. GUADALUPE RD #120
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233
Practice Address - Country:US
Practice Address - Phone:480-926-7800
Practice Address - Fax:480-926-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty