Provider Demographics
NPI:1023560877
Name:BERG, JORDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:BERG
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 1:434 S. KIWANIS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-3741
Mailing Address - Country:US
Mailing Address - Phone:605-332-7706
Mailing Address - Fax:605-332-2430
Practice Address - Street 1:434 S. KIWANIS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-3741
Practice Address - Country:US
Practice Address - Phone:605-332-7706
Practice Address - Fax:605-332-2430
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor