Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0200X | Radiology | 08001646 | IN |
N | 213ER0200X | Radiology | 08001646 | IN |
Y | 111NR0400X | Rehabilitation Chiropractor | 08001646 | IN |
NPI | 1003904210 |
---|---|
Provider Name | Eric J Berseth |
First Address | Madison, IN 47250-1636 |
Second Address | Madison, IN 47250-1636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 25/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200095140 | (05) | IN |
U81614 | (02) | IN |