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NPI Code Detail

MEDICARE: DR. PHILIP GEORGE BERENT D.C.

MEDICARE: DR. PHILIP GEORGE BERENT D.C.
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
1111N00000XChiropractor2301004763MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111271830OTHERMI(CAQH)
2950G6511OTHERMIBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1457571499
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILIP GEORGE BERENT D.C.
Provider Business Mailing Address
First Line : 3850 MCKINLEY ST
Second Line :
City : DEARBORN
State : MI
Zip : 48124-3674
Country : US
Telephone Number : 313-562-4919
Fax Number :
Provider Business Practice Location Address
First Line : 125 SAINT MARY DR
Second Line :
City : PORT SANILAC
State : MI
Zip : 48469-9656
Country : US
Telephone Number : 810-622-8202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 07/08/2007

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