Provider Demographics
NPI:1205053816
Name:RONALD W. BERG CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:RONALD W. BERG CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-367-5133
Mailing Address - Street 1:24005 RACETRACK ST
Mailing Address - Street 2:
Mailing Address - City:FORESTHILL
Mailing Address - State:CA
Mailing Address - Zip Code:95631-9406
Mailing Address - Country:US
Mailing Address - Phone:530-367-5133
Mailing Address - Fax:530-367-4728
Practice Address - Street 1:24005 RACETRACK ST
Practice Address - Street 2:
Practice Address - City:FORESTHILL
Practice Address - State:CA
Practice Address - Zip Code:95631-9406
Practice Address - Country:US
Practice Address - Phone:530-367-5133
Practice Address - Fax:530-367-4728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29130ZMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER