MEDICARE: JOHN BERLIN 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	1104	NM

General Provider Information

NPI Number	:	1992893077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BERLIN D.C.

Provider Business Mailing Address
First Line	:	2622 SAN MATEO BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3130
Country	:	US
Telephone Number	:	505-888-0331
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 JUAN TABO BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3302
Country	:	US
Telephone Number	:	505-296-0296
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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