Provider Demographics
NPI:1053503714
Name:BERMAN CHIROPRACTIC AND WELLNESS LLC
Entity Type:Organization
Organization Name:BERMAN CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-862-5700
Mailing Address - Street 1:112 S HANLEY RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3418
Mailing Address - Country:US
Mailing Address - Phone:314-862-5700
Mailing Address - Fax:314-862-6258
Practice Address - Street 1:112 S HANLEY RD
Practice Address - Street 2:SUITE 130
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3418
Practice Address - Country:US
Practice Address - Phone:314-862-5700
Practice Address - Fax:314-862-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001030176302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO322365426OtherMEDICARE PTAN