Basic Information
| Provider Information | |||||||||
| NPI: | 1609930155 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERLIN CHIROPRACTIC CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6221 WILSHIRE BLVD | ||||||||
| Address2: | 518 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235490070 | ||||||||
| FaxNumber: | 3235490440 | ||||||||
| Practice Location | |||||||||
| Address1: | 6221 WILSHIRE BLVD | ||||||||
| Address2: | 518 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235490070 | ||||||||
| FaxNumber: | 3235490440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 07/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | BERLIN | ||||||||
| AuthorizedOfficialFirstName: | ELLIOT | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIROPRACTOR | ||||||||
| AuthorizedOfficialTelephone: | 3235490070 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC29037 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.