Provider Demographics
NPI:1720609639
Name:BERKELEY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BERKELEY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KOROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKERI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-547-1222
Mailing Address - Street 1:15520 ROCKFIELD BLVD
Mailing Address - Street 2:STE A200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-6705
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:1533 SHATTUCK AVE
Practice Address - Street 2:STE A
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1516
Practice Address - Country:US
Practice Address - Phone:510-547-1222
Practice Address - Fax:510-666-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty