Provider Demographics
NPI:1639497928
Name:BERLENER CHIROPRACTIC P C
Entity Type:Organization
Organization Name:BERLENER CHIROPRACTIC P C
Other - Org Name:DISCOVER WELLNESS & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BERLENER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-636-6400
Mailing Address - Street 1:3216 EMERALD LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6947
Mailing Address - Country:US
Mailing Address - Phone:573-636-6400
Mailing Address - Fax:573-636-6401
Practice Address - Street 1:3216 EMERALD LN
Practice Address - Street 2:SUITE A
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6947
Practice Address - Country:US
Practice Address - Phone:573-636-6400
Practice Address - Fax:573-636-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006010204111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty