Provider Demographics
NPI:1083952303
Name:BERMAN, SCOTT BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BRIAN
Last Name:BERMAN
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 1:171 E THOUSAND OAKS BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5741
Mailing Address - Country:US
Mailing Address - Phone:805-379-9700
Mailing Address - Fax:805-379-1991
Practice Address - Street 1:171 E THOUSAND OAKS BLVD STE 105
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5741
Practice Address - Country:US
Practice Address - Phone:805-379-9700
Practice Address - Fax:805-379-1991
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor