Provider Demographics
NPI:1700162302
Name:DR. JODI BERGS INTEGRATIVE FAMILY HEALTH CLINIC
Entity Type:Organization
Organization Name:DR. JODI BERGS INTEGRATIVE FAMILY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-258-2325
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:888-431-8819
Practice Address - Street 1:3903 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4926
Practice Address - Country:US
Practice Address - Phone:425-258-2325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. JODI BERGS INTEGRATIVE FAMILY HEALTH CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-26
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site