Healthcare Provider Details

I. General information

NPI: 1992893077
Provider Name (Legal Business Name): JOHN BERLIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 JUAN TABO BLVD NE
ALBUQUERQUE NM
87112-3302
US

IV. Provider business mailing address

2622 SAN MATEO BLVD NE
ALBUQUERQUE NM
87110-3130
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-0296
  • Fax:
Mailing address:
  • Phone: 505-888-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1104
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: