Provider Demographics
NPI:1811622806
Name:BERCK, DAVID (ATC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BERCK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7890 E SPRING ST UNIT 11L
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1622
Mailing Address - Country:US
Mailing Address - Phone:323-497-2719
Mailing Address - Fax:
Practice Address - Street 1:1111 E ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-5314
Practice Address - Country:US
Practice Address - Phone:310-900-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer