Provider Demographics
NPI:1831283514
Name:BERGER BODYSATTVA CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:BERGER BODYSATTVA CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-497-0300
Mailing Address - Street 1:1414 E. THOUSAND OAKS BLVD.
Mailing Address - Street 2:SUITE 211
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:805-497-0300
Mailing Address - Fax:805-497-9321
Practice Address - Street 1:1414 E. THOUSAND OAKS BLVD.
Practice Address - Street 2:SUITE 211
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-497-0300
Practice Address - Fax:805-497-9321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty