Provider Demographics
NPI:1528199080
Name:BERK & GRENDA CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:BERK & GRENDA CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GRENDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-518-1200
Mailing Address - Street 1:612 N AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-5808
Mailing Address - Country:US
Mailing Address - Phone:310-518-1200
Mailing Address - Fax:310-518-1222
Practice Address - Street 1:612 N AVALON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-5808
Practice Address - Country:US
Practice Address - Phone:310-518-1200
Practice Address - Fax:310-518-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23471111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty