Provider Demographics
NPI:1003904210
Name:BERSETH, ERIC J (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:BERSETH
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 1:2432 CLIFTY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-1636
Mailing Address - Country:US
Mailing Address - Phone:812-265-1000
Mailing Address - Fax:812-265-6994
Practice Address - Street 1:2432 CLIFTY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1636
Practice Address - Country:US
Practice Address - Phone:812-265-1000
Practice Address - Fax:812-265-6994
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001646111NR0200X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200095140Medicaid
IN200095140Medicaid
INU81614Medicare UPIN