Healthcare Provider Details

I. General information

NPI: 1992329569
Provider Name (Legal Business Name): BERARDI ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2020
Last Update Date: 05/30/2020
Certification Date: 05/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 POPLAR AVE STE 113
MEMPHIS TN
38119-4882
US

IV. Provider business mailing address

3675 SUMMER AVE
MEMPHIS TN
38122-3742
US

V. Phone/Fax

Practice location:
  • Phone: 731-445-7278
  • Fax:
Mailing address:
  • Phone: 901-323-3613
  • Fax: 901-454-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILIP J BERARDI
Title or Position: OWNER
Credential: DC
Phone: 901-323-3613