Provider Demographics
NPI:1003979329
Name:BERLIN CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:BERLIN CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-963-8750
Mailing Address - Street 1:4360 S REDWOOD RD STE 3
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2204
Mailing Address - Country:US
Mailing Address - Phone:801-963-8750
Mailing Address - Fax:801-967-2494
Practice Address - Street 1:4360 S REDWOOD RD STE 3
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-2204
Practice Address - Country:US
Practice Address - Phone:801-963-8750
Practice Address - Fax:801-967-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT289844-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056171Medicare ID - Type UnspecifiedCHIROPRACTOR