Healthcare Provider Details

I. General information

NPI: 1215156831
Provider Name (Legal Business Name): MATTHEW DAN BERMAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S HANLEY RD SUITE 130
CLAYTON MO
63105-3418
US

IV. Provider business mailing address

112 S HANLEY RD SUITE 130
CLAYTON MO
63105-3418
US

V. Phone/Fax

Practice location:
  • Phone: 314-862-5700
  • Fax: 314-862-6258
Mailing address:
  • Phone: 314-862-5700
  • Fax: 314-862-6258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2001030176
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: