Provider Demographics
NPI:1194752113
Name:BERARDINO, ANTHONY FRANK (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:FRANK
Last Name:BERARDINO
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 1:237 LEATHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9236
Mailing Address - Country:US
Mailing Address - Phone:330-336-2120
Mailing Address - Fax:330-334-8305
Practice Address - Street 1:237 LEATHERMAN RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9236
Practice Address - Country:US
Practice Address - Phone:330-336-2120
Practice Address - Fax:330-334-8305
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4185051Medicare PIN