Provider Demographics
NPI:1972687762
Name:BERKLICH, JEFFREY (DC MPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BERKLICH
Suffix:
Gender:M
Credentials:DC MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 CAMBRIDGE SQ
Mailing Address - Street 2:STE B
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1865
Mailing Address - Country:US
Mailing Address - Phone:770-475-2225
Mailing Address - Fax:770-664-4718
Practice Address - Street 1:1101 CAMBRIDGE SQ
Practice Address - Street 2:STE B
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-1865
Practice Address - Country:US
Practice Address - Phone:770-475-2225
Practice Address - Fax:770-664-4718
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1911111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52156776001OtherBLUE SHIELD PROVIDER ID
GAT97475Medicare UPIN