Provider Demographics
NPI:1235209685
Name:BERGER, TED A (DC)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:A
Last Name:BERGER
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 1:7574 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2563
Mailing Address - Country:US
Mailing Address - Phone:954-243-7246
Mailing Address - Fax:954-961-7562
Practice Address - Street 1:7574 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2563
Practice Address - Country:US
Practice Address - Phone:954-927-7246
Practice Address - Fax:954-961-7562
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70164Medicare ID - Type Unspecified