Provider Demographics
NPI:1255462099
Name:BERARD, JEFFREY TUCKER (BA, DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TUCKER
Last Name:BERARD
Suffix:
Gender:M
Credentials:BA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 EASTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48641-1824
Mailing Address - Country:US
Mailing Address - Phone:772-359-8108
Mailing Address - Fax:
Practice Address - Street 1:286 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3341
Practice Address - Country:US
Practice Address - Phone:954-452-4600
Practice Address - Fax:954-452-4652
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381463700Medicaid
FL70255Medicare ID - Type Unspecified
FL651124725Medicare UPIN