Provider Demographics
NPI:1386628238
Name:BERARDI, DARRIN DAVID (DC)
Entity Type:Individual
Prefix:
First Name:DARRIN
Middle Name:DAVID
Last Name:BERARDI
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 1:1590 WEBSTER ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4992
Mailing Address - Country:US
Mailing Address - Phone:707-425-1021
Mailing Address - Fax:707-425-4851
Practice Address - Street 1:1590 WEBSTER ST
Practice Address - Street 2:SUITE D
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4992
Practice Address - Country:US
Practice Address - Phone:707-425-1021
Practice Address - Fax:707-425-4851
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U76738Medicare UPIN
DC0205110Medicare ID - Type Unspecified