Provider Demographics
NPI:1053681254
Name:DR LESLIE BETH BERMAN PC
Entity Type:Organization
Organization Name:DR LESLIE BETH BERMAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-754-0054
Mailing Address - Street 1:2438 NW PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3991
Mailing Address - Country:US
Mailing Address - Phone:541-754-0054
Mailing Address - Fax:888-315-8835
Practice Address - Street 1:2438 NW PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3991
Practice Address - Country:US
Practice Address - Phone:541-754-0054
Practice Address - Fax:888-315-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty