Provider Demographics
NPI:1093900367
Name:BERG, HOWARD A (DC)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:A
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 1:132 RETREAT PLZ
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2426
Mailing Address - Country:US
Mailing Address - Phone:912-638-2245
Mailing Address - Fax:
Practice Address - Street 1:132 RETREAT PLZ
Practice Address - Street 2:SUITE B
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2426
Practice Address - Country:US
Practice Address - Phone:912-638-2245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP 4423OtherMCR GRP
U70774Medicare UPIN
GA35ZCGSTMedicare PIN