Provider Demographics
NPI:1942459326
Name:BERARDIS FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:BERARDIS FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BERARDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-962-1234
Mailing Address - Street 1:1010 E MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-1534
Mailing Address - Country:US
Mailing Address - Phone:914-962-1234
Mailing Address - Fax:914-962-1312
Practice Address - Street 1:1010 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SHRUB OAK
Practice Address - State:NY
Practice Address - Zip Code:10588-1534
Practice Address - Country:US
Practice Address - Phone:914-962-1234
Practice Address - Fax:914-962-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005871-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC05871-1OtherWORKER'S COMPENSATION
NY0015178OtherGHI
NYP439476OtherOXFORD
NYX35591OtherBC/BS
NYX35591Medicare PIN