Provider Demographics
NPI:1720354392
Name:TED BERGER DC PA
Entity Type:Organization
Organization Name:TED BERGER DC PA
Other - Org Name:ACTION CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC,PA
Authorized Official - Phone:954-927-7246
Mailing Address - Street 1:7574 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2563
Mailing Address - Country:US
Mailing Address - Phone:954-927-7246
Mailing Address - Fax:954-961-7562
Practice Address - Street 1:7574 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2563
Practice Address - Country:US
Practice Address - Phone:954-927-7246
Practice Address - Fax:954-961-7562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381595100Medicaid