Provider Demographics
NPI:1922174762
Name:BERMAN, DAVID ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:BERMAN
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 1:102 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1272
Mailing Address - Country:US
Mailing Address - Phone:440-286-2225
Mailing Address - Fax:440-286-3058
Practice Address - Street 1:102 E PARK ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1237
Practice Address - Country:US
Practice Address - Phone:440-286-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2304876Medicaid
OHU88995Medicare UPIN
OHBE 4069481Medicare ID - Type Unspecified
OH2304876Medicaid