Provider Demographics
NPI:1972747954
Name:BERARDIS FAMILY CHIROPRACTIC, PC
Entity type:Organization
Organization Name:BERARDIS FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BERARDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-962-1234
Mailing Address - Street 1:3671 OLD YORKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-1503
Mailing Address - Country:US
Mailing Address - Phone:914-962-1234
Mailing Address - Fax:914-962-1312
Practice Address - Street 1:3671 OLD YORKTOWN RD
Practice Address - Street 2:
Practice Address - City:SHRUB OAK
Practice Address - State:NY
Practice Address - Zip Code:10588-1503
Practice Address - Country:US
Practice Address - Phone:914-962-1234
Practice Address - Fax:914-962-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty