MEDICARE: DR. MARK C BERKLEY DC CCSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC003459L	PA
2	111NS0005X	Sports Physician Chiropractor	DC003459L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	505383	OTHER	PA	HIMARK BCBS

General Provider Information

NPI Number	:	1003919143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK C BERKLEY DC CCSP

Provider Business Mailing Address
First Line	:	88 CENTER CHURCH RD
Second Line	:
City	:	MC MURRAY
State	:	PA
Zip	:	15317-3002
Country	:	US
Telephone Number	:	724-941-6202
Fax Number	:	724-941-6001

Provider Business Practice Location Address
First Line	:	88 CENTER CHURCH RD
Second Line	:
City	:	MC MURRAY
State	:	PA
Zip	:	15317-3002
Country	:	US
Telephone Number	:	724-941-6202
Fax Number	:	724-941-6001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/17/2010

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