Provider Demographics
NPI:1760518641
Name:BERG, RONALD WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:WILLIAM
Last Name:BERG
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:PO BOX 1430
Mailing Address - Street 2:24005 RACETRACK ST.
Mailing Address - City:FORESTHILL
Mailing Address - State:CA
Mailing Address - Zip Code:95631-1430
Mailing Address - Country:US
Mailing Address - Phone:530-367-5133
Mailing Address - Fax:530-367-4728
Practice Address - Street 1:24005 RACETRACK ST.
Practice Address - Street 2:
Practice Address - City:FORESTHILL
Practice Address - State:CA
Practice Address - Zip Code:95631-1430
Practice Address - Country:US
Practice Address - Phone:530-367-5133
Practice Address - Fax:530-367-4728
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0263431Medicare ID - Type UnspecifiedPROVIDER I.D. #