Provider Demographics
NPI:1386946150
Name:BERARDI CHIROPRACTIC CLINIC PC
Entity type:Organization
Organization Name:BERARDI CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BERARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-425-1021
Mailing Address - Street 1:1590 WEBSTER ST.
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533
Mailing Address - Country:US
Mailing Address - Phone:707-425-1021
Mailing Address - Fax:707-425-4851
Practice Address - Street 1:1590 WEBSTER ST.
Practice Address - Street 2:SUITE D
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533
Practice Address - Country:US
Practice Address - Phone:707-425-1021
Practice Address - Fax:707-425-4851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERARDI CHIROPRACTIC CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-29
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U76738Medicare UPIN