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General NPI Number Information
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NPI Number | 1679989404
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Entity Type | Individual
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Provider Name | JOSHUA BERVEN DC
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Gender | Male
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 641 W STEPHENSON ST
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City | FREEPORT
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State | IL
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Zip | 61032-5005
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Country | US
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Telephone | 815-238-9629
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Fax |
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Provider Business Mailing Address
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Address Line | 6921 ALVINA RD
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City | ROCKFORD
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State | IL
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Zip | 61101-7950
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Country | US
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Telephone | 515-570-7297
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.013304
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License Number State | IL
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