Provider Demographics
NPI:1982692547
Name:BERBESSI, LUIS EDUARDO (DC)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:EDUARDO
Last Name:BERBESSI
Suffix:
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 1:1872 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-2668
Mailing Address - Country:US
Mailing Address - Phone:706-367-7644
Mailing Address - Fax:706-367-7644
Practice Address - Street 1:1872 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-2668
Practice Address - Country:US
Practice Address - Phone:706-367-7644
Practice Address - Fax:706-367-7644
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU66695Medicare UPIN
GA35ZCGXWMedicare ID - Type UnspecifiedPROVIDER