Provider Demographics
NPI:1689717969
Name:CHRISTIE, HENRY BERGES JR (DC)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:BERGES
Last Name:CHRISTIE
Suffix:JR
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 1:116 W WASHINGTON ST
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-1543
Mailing Address - Country:US
Mailing Address - Phone:304-725-9622
Mailing Address - Fax:304-725-9622
Practice Address - Street 1:116 W WASHINGTON ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1543
Practice Address - Country:US
Practice Address - Phone:304-725-9622
Practice Address - Fax:304-725-9622
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0132413000Medicaid
WV0132413000Medicaid
T32368Medicare UPIN