Provider Demographics
NPI:1336209667
Name:BERMAN, GLEN (DC)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 W MCNAB RD STE 128
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-3203
Mailing Address - Country:US
Mailing Address - Phone:954-726-8424
Mailing Address - Fax:954-572-4409
Practice Address - Street 1:8333 W MCNAB RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-3242
Practice Address - Country:US
Practice Address - Phone:954-726-8424
Practice Address - Fax:954-572-4409
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20298Medicare UPIN
FL22667Medicare ID - Type Unspecified