Provider Demographics
NPI:1285692160
Name:BERG, SARA S (DC)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:S
Last Name:BERG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3011 BROADWAY ST
Mailing Address - Street 2:#11
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3100
Mailing Address - Country:US
Mailing Address - Phone:720-470-4016
Mailing Address - Fax:303-449-5756
Practice Address - Street 1:3011 BROADWAY ST
Practice Address - Street 2:#11
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3100
Practice Address - Country:US
Practice Address - Phone:720-470-4016
Practice Address - Fax:303-449-5756
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor