Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC003459L | PA |
N | 111NS0005X | Chiropractic Sports Physician | DC003459L | PA |
NPI | 1003919143 |
---|---|
Provider Name | Dr. Mark C Berkley |
First Address | Mc Murray, PA 15317-3002 |
Second Address | Mc Murray, PA 15317-3002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 17/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
505383 | HIMARK BCBS (01) | PA |
U18196 | (02) |