Provider Demographics
NPI:1871994160
Name:BERG, JUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:BERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2541 N PLEASANTBURG DR
Mailing Address - Street 2:SUITE R
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-2728
Mailing Address - Country:US
Mailing Address - Phone:864-354-5467
Mailing Address - Fax:
Practice Address - Street 1:2541 N PLEASANTBURG DR
Practice Address - Street 2:SUITE R
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-2728
Practice Address - Country:US
Practice Address - Phone:864-354-5467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDC3954DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor