Healthcare Provider Details

I. General information

NPI: 1609980200
Provider Name (Legal Business Name): EVAN BRUCE BERK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 S DOHENY DR
BEVERLY HILLS CA
90211-2509
US

IV. Provider business mailing address

153 S DOHENY DR
BEVERLY HILLS CA
90211-2509
US

V. Phone/Fax

Practice location:
  • Phone: 310-888-8896
  • Fax: 310-888-0133
Mailing address:
  • Phone: 310-888-8896
  • Fax: 310-888-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC22593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: