Provider Demographics
NPI:1487862843
Name:BERLIN, DANIEL A (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:BERLIN
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 1:4360 S REDWOOD RD
Mailing Address - Street 2:STE 3
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2204
Mailing Address - Country:US
Mailing Address - Phone:801-963-8750
Mailing Address - Fax:801-967-2494
Practice Address - Street 1:4360 S REDWOOD RD
Practice Address - Street 2:# 3
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-2203
Practice Address - Country:US
Practice Address - Phone:801-963-8750
Practice Address - Fax:801-967-2494
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT289844-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056171Medicare PIN
UTU59187Medicare UPIN