Provider Demographics
NPI:1912093147
Name:BERG, JONATHAN S II (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:BERG
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 PINION DRIVE, 10MDG
Mailing Address - Street 2:
Mailing Address - City:ASAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-2502
Mailing Address - Country:US
Mailing Address - Phone:719-333-3107
Mailing Address - Fax:978-477-0213
Practice Address - Street 1:4102 PINION DR, 10MDG
Practice Address - Street 2:
Practice Address - City:ASAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-3107
Practice Address - Fax:978-477-0213
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH1766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1609998Medicaid
MABEY36332OtherBLUE CROSS / BLUE SHIELD
MABEY36332OtherBLUE CROSS / BLUE SHIELD