Provider Demographics
NPI:1588829964
Name:BERCHENKO, EUGENE ALEX (DC)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ALEX
Last Name:BERCHENKO
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 1:540 N CENTRAL AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3357
Mailing Address - Country:US
Mailing Address - Phone:818-240-6500
Mailing Address - Fax:818-240-6644
Practice Address - Street 1:540 N CENTRAL AVE STE 306
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3357
Practice Address - Country:US
Practice Address - Phone:818-240-6500
Practice Address - Fax:818-240-6644
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor