Provider Demographics
NPI:1407052657
Name:BERK, JAMIE BRIAN (DC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:BRIAN
Last Name:BERK
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 1:2313 BRIGANTINE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2092
Mailing Address - Country:US
Mailing Address - Phone:586-799-2375
Mailing Address - Fax:
Practice Address - Street 1:2313 BRIGANTINE
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-2092
Practice Address - Country:US
Practice Address - Phone:586-799-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ118896Medicare PIN
AZ1407052657OtherNPI