Provider Demographics
NPI:1992739437
Name:LAURA BERG, PC
Entity type:Organization
Organization Name:LAURA BERG, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-371-3533
Mailing Address - Street 1:1905 W 57TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2893
Mailing Address - Country:US
Mailing Address - Phone:605-371-3533
Mailing Address - Fax:605-371-1781
Practice Address - Street 1:1905 W 57TH ST STE 3
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2893
Practice Address - Country:US
Practice Address - Phone:605-371-3533
Practice Address - Fax:605-371-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty