Provider Demographics
NPI:1023160959
Name:BERNAL, GEORGE C
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:C
Last Name:BERNAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12103 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2636
Mailing Address - Country:US
Mailing Address - Phone:562-861-1287
Mailing Address - Fax:562-923-0387
Practice Address - Street 1:12103 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2636
Practice Address - Country:US
Practice Address - Phone:562-861-1287
Practice Address - Fax:562-923-0387
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor