Provider Demographics
NPI:1639246960
Name:JUSTIN J. BERLIN, D.C., PLC
Entity Type:Organization
Organization Name:JUSTIN J. BERLIN, D.C., PLC
Other - Org Name:DELTA CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-879-5540
Mailing Address - Street 1:5909 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3867
Mailing Address - Country:US
Mailing Address - Phone:248-879-5540
Mailing Address - Fax:248-879-5502
Practice Address - Street 1:5909 JOHN R RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3867
Practice Address - Country:US
Practice Address - Phone:248-879-5540
Practice Address - Fax:248-879-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F334880OtherBCBSM PIN#