Provider Demographics
NPI:1881622363
Name:BERK, JACQUELINE BETH (DC)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:BETH
Last Name:BERK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:BETH
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:325 S CHARLES G SEIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-3942
Mailing Address - Country:US
Mailing Address - Phone:865-457-8888
Mailing Address - Fax:865-457-8886
Practice Address - Street 1:325 S CHARLES G SEIVERS BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3942
Practice Address - Country:US
Practice Address - Phone:865-457-8888
Practice Address - Fax:865-457-8886
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3036656OtherBLUE CROSS
TN3678428Medicaid
TN3678429Medicare ID - Type Unspecified
TN3036656OtherBLUE CROSS