Provider Demographics
NPI:1609980200
Name:BERK, EVAN BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:BRUCE
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 1:153 S DOHENY DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2509
Mailing Address - Country:US
Mailing Address - Phone:310-888-8896
Mailing Address - Fax:310-888-0133
Practice Address - Street 1:153 S DOHENY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2509
Practice Address - Country:US
Practice Address - Phone:310-888-8896
Practice Address - Fax:310-888-0133
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22593OtherLICENSE NUMBER
CADC22593OtherLICENSE NUMBER