Provider Demographics
NPI:1679582233
Name:BERMAN, WILLIAM S (DC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:S
Last Name:BERMAN
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 1:128 SILVER MAPLE DR
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659
Mailing Address - Country:US
Mailing Address - Phone:423-926-9100
Mailing Address - Fax:423-926-9200
Practice Address - Street 1:110 UNIVERSITY PKWY
Practice Address - Street 2:SUITE # 201
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-926-9100
Practice Address - Fax:423-926-9200
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2482111N00000X
LA575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT75551Medicare UPIN
TN103I354121Medicare PIN
LA59420Medicare ID - Type Unspecified