Healthcare Provider Details

I. General information

NPI: 1639497928
Provider Name (Legal Business Name): BERLENER CHIROPRACTIC P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 EMERALD LN SUITE A
JEFFERSON CITY MO
65109-6947
US

IV. Provider business mailing address

3216 EMERALD LN SUITE A
JEFFERSON CITY MO
65109-6947
US

V. Phone/Fax

Practice location:
  • Phone: 573-636-6400
  • Fax: 573-636-6401
Mailing address:
  • Phone: 573-636-6400
  • Fax: 573-636-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2006010204
License Number StateMO

VIII. Authorized Official

Name: DR. BRENT RAY BERLENER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 573-636-6400