Provider Demographics
NPI:1871972083
Name:GREGORY M. BERKOFF D.C., INC., DOCTOR OF CHIROPRACTIC, A PROF CORP.
Entity type:Organization
Organization Name:GREGORY M. BERKOFF D.C., INC., DOCTOR OF CHIROPRACTIC, A PROF CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-999-5153
Mailing Address - Street 1:4520 EXECUTIVE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3018
Mailing Address - Country:US
Mailing Address - Phone:858-622-9459
Mailing Address - Fax:858-622-9458
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE C129
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1707
Practice Address - Country:US
Practice Address - Phone:858-622-9459
Practice Address - Fax:858-622-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty