Provider Demographics
NPI:1851408769
Name:BERARD, SHAWN M
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:M
Last Name:BERARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 RODEO DR STE 3
Mailing Address - Street 2:PO BOX 808
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6826
Mailing Address - Country:US
Mailing Address - Phone:406-273-4640
Mailing Address - Fax:406-273-7765
Practice Address - Street 1:289 RODEO DR STE 3
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6826
Practice Address - Country:US
Practice Address - Phone:406-273-4640
Practice Address - Fax:406-273-7765
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTU54860Medicare UPIN