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General NPI Number Information
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NPI Number | 1023516473
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Entity Type | Individual
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Provider Name | MICHAEL BERGER LAC
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Gender | Male
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 01/30/2018
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Provider Practice Location Address
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Address Line | 3194 S 1100 E STE 102
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-2526
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Country | US
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Telephone | 385-888-6900
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Fax | 385-888-6900
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Provider Business Mailing Address
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Address Line | 928 EAGLE WAY
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-3330
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Country | US
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Telephone | 385-888-6900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 8677222-1201
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License Number State | UT
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