Provider Demographics
NPI:1164408803
Name:BERG, CHARLES SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SCOTT
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 1:674 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6307
Mailing Address - Country:US
Mailing Address - Phone:201-666-5300
Mailing Address - Fax:201-666-4951
Practice Address - Street 1:674 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIVERVALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6307
Practice Address - Country:US
Practice Address - Phone:201-666-5300
Practice Address - Fax:201-666-4951
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00162500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ461139Medicare PIN