Provider Demographics
NPI:1962546119
Name:BERG, JODI L (ND, LAC, LMP, MS RDE)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:L
Last Name:BERG
Suffix:
Gender:F
Credentials:ND, LAC, LMP, MS RDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 COLBY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4926
Mailing Address - Country:US
Mailing Address - Phone:425-258-2325
Mailing Address - Fax:
Practice Address - Street 1:3903 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4926
Practice Address - Country:US
Practice Address - Phone:425-258-2325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000687171100000X
WANT00000923175F00000X
WAMA00012057225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist