Provider Demographics
NPI:1134156995
Name:BERMAN, LESLIE B (DC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:B
Last Name:BERMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 NW PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330
Mailing Address - Country:US
Mailing Address - Phone:541-754-0054
Mailing Address - Fax:541-754-0363
Practice Address - Street 1:2438 NW PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-754-0054
Practice Address - Fax:541-754-0363
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QD6ZLMedicare ID - Type Unspecified
T67424Medicare UPIN