Provider Demographics
NPI:1902040595
Name:BERGER, RONALD L (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:BERGER
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 1:18700 WOLF RD
Mailing Address - Street 2:STE 211
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8603
Mailing Address - Country:US
Mailing Address - Phone:563-271-4692
Mailing Address - Fax:
Practice Address - Street 1:18700 S WOLF RD
Practice Address - Street 2:SUITE 211
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8456
Practice Address - Country:US
Practice Address - Phone:708-478-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor