Healthcare Provider Details

I. General information

NPI: 1982805818
Provider Name (Legal Business Name): LISA RESCA BERGER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 BROOKSTONE CT
LAS VEGAS NV
89117-2443
US

IV. Provider business mailing address

2721 BROOKSTONE CT
LAS VEGAS NV
89117-2443
US

V. Phone/Fax

Practice location:
  • Phone: 702-838-0294
  • Fax:
Mailing address:
  • Phone: 702-838-0294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberBO1236
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC16207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: