Provider Demographics
NPI:1023561701
Name:BERARDI BLAIR, MICHELE ANGELA (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ANGELA
Last Name:BERARDI BLAIR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:ANGELA
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:203 HUNTERS RUN
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-3038
Mailing Address - Country:US
Mailing Address - Phone:856-693-6526
Mailing Address - Fax:
Practice Address - Street 1:511 BECKETT RD
Practice Address - Street 2:
Practice Address - City:LOGAN TWP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1865
Practice Address - Country:US
Practice Address - Phone:856-272-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00736200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor