Provider Demographics
NPI:1275680399
Name:BERMAN FAMILY CHIROPRACTIC & SPORTS CARE CENTRE PA
Entity Type:Organization
Organization Name:BERMAN FAMILY CHIROPRACTIC & SPORTS CARE CENTRE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-726-8424
Mailing Address - Street 1:8333 W MCNAB RD STE 128
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-3203
Mailing Address - Country:US
Mailing Address - Phone:954-726-8424
Mailing Address - Fax:954-572-4409
Practice Address - Street 1:8333 W MCNAB RD STE 128
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-3203
Practice Address - Country:US
Practice Address - Phone:954-726-8424
Practice Address - Fax:954-726-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20298Medicare UPIN
FL22667Medicare ID - Type Unspecified