Provider Demographics
NPI:1952618506
Name:BERG, ROSEANN LEAH (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSEANN
Middle Name:LEAH
Last Name:BERG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12345 30TH AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5436
Mailing Address - Country:US
Mailing Address - Phone:206-227-5133
Mailing Address - Fax:
Practice Address - Street 1:12345 30TH AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5436
Practice Address - Country:US
Practice Address - Phone:206-227-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60175372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor