Provider Demographics
NPI:1306905161
Name:BERNARD, BRIAN BRENT (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:BRENT
Last Name:BERNARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4031
Mailing Address - Country:US
Mailing Address - Phone:940-696-9007
Mailing Address - Fax:940-723-0807
Practice Address - Street 1:2304 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4031
Practice Address - Country:US
Practice Address - Phone:940-696-9007
Practice Address - Fax:940-723-0807
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1144213570OtherP.A. NPI NUMBER
TX165670101Medicaid
8CG501OtherBCBS
TXU97255Medicare UPIN
8CG501OtherBCBS