Provider Demographics
NPI:1699785915
Name:BERGER, BURTON (DC)
Entity type:Individual
Prefix:DR
First Name:BURTON
Middle Name:
Last Name:BERGER
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 1:5634 DYER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5004
Mailing Address - Country:US
Mailing Address - Phone:214-219-3900
Mailing Address - Fax:214-219-1207
Practice Address - Street 1:5634 DYER ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5004
Practice Address - Country:US
Practice Address - Phone:214-219-3900
Practice Address - Fax:214-219-1207
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC9500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V02375Medicare UPIN
8C8453Medicare ID - Type Unspecified