Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 3478 | MA |
N | 111NR0400X | Rehabilitation Chiropractor | X012124-1 | NY |
NPI | 1255637666 |
---|---|
Provider Name | Dr. Eli Zachary Berk |
First Address | Hadley, MA 01035-3534 |
Second Address | Hadley, MA 01035-3534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2011 |
Last Update Date | 02/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S300199096 | MEDICARE ID (01) | MA |