Provider Demographics
NPI:1174599666
Name:BERARD, PAUL RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:BERARD
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 1:1445 BURTON HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:BARTON
Mailing Address - State:VT
Mailing Address - Zip Code:05822-4406
Mailing Address - Country:US
Mailing Address - Phone:802-334-0202
Mailing Address - Fax:802-525-4533
Practice Address - Street 1:1445 BURTON HILL ROAD
Practice Address - Street 2:
Practice Address - City:BARTON
Practice Address - State:VT
Practice Address - Zip Code:05822-4406
Practice Address - Country:US
Practice Address - Phone:802-334-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0000891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN0162Medicaid
VT18461OtherBC/BS
VT244-6224OtherCIGNA
VT18461OtherBC/BS
VTVN0162Medicaid
VTVN0162Medicare ID - Type Unspecified