MEDICARE: DR. KIMBERLY ANN BERKUS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3505	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	112L3BE	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1922129527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY ANN BERKUS D.C.

Provider Business Mailing Address
First Line	:	2101 HENNEPIN AVE S
Second Line	:	STE. 101
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2769
Country	:	US
Telephone Number	:	612-870-6100
Fax Number	:	612-870-6286

Provider Business Practice Location Address
First Line	:	2101 HENNEPIN AVE S
Second Line	:	STE. 101
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2769
Country	:	US
Telephone Number	:	612-870-6100
Fax Number	:	612-870-6286

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	02/11/2009

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