Healthcare Provider Details

I. General information

NPI: 1003919143
Provider Name (Legal Business Name): MARK C BERKLEY DC CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 CENTER CHURCH RD
MC MURRAY PA
15317-3002
US

IV. Provider business mailing address

88 CENTER CHURCH RD
MC MURRAY PA
15317-3002
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-6202
  • Fax: 724-941-6001
Mailing address:
  • Phone: 724-941-6202
  • Fax: 724-941-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC003459L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC003459L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier505383
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIMARK BCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: