Provider Demographics
NPI:1700919834
Name:CLIFTY FALLS CHIROPRACTIC CENTER, P.S.C.
Entity Type:Organization
Organization Name:CLIFTY FALLS CHIROPRACTIC CENTER, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERSETH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-265-1000
Mailing Address - Street 1:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-0902
Mailing Address - Country:US
Mailing Address - Phone:812-265-1000
Mailing Address - Fax:812-265-6994
Practice Address - Street 1:2432 CLIFTY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1636
Practice Address - Country:US
Practice Address - Phone:812-265-1000
Practice Address - Fax:812-265-6994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty