Provider Demographics
NPI:1003919143
Name:BERKLEY, MARK C (DC CCSP)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:BERKLEY
Suffix:
Gender:M
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CENTER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3002
Mailing Address - Country:US
Mailing Address - Phone:724-941-6202
Mailing Address - Fax:724-941-6001
Practice Address - Street 1:88 CENTER CHURCH RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3002
Practice Address - Country:US
Practice Address - Phone:724-941-6202
Practice Address - Fax:724-941-6001
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003459L111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA505383OtherHIMARK BCBS
U18196Medicare UPIN