=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841559150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRAIG BERKO, D.C., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2012
-----------------------------------------------------
Last Update Date | 05/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 ARTHUR GODFREY RD STE 412
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-305-8672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2016 BAY DR APT 503
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33141-4421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-305-8672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/ PRESIDENT
-----------------------------------------------------
Name | DR. CRAIG BERKO
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 305-305-8672
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | CH6209
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------