Provider Demographics
NPI:1356376354
Name:BERMAN, SCOTT JASON (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:JASON
Last Name:BERMAN
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 1:869 JOHN MARSHALL HWY STE B
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-4578
Mailing Address - Country:US
Mailing Address - Phone:540-636-8770
Mailing Address - Fax:540-636-8771
Practice Address - Street 1:869 JOHN MARSHALL HWY STE B
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-4578
Practice Address - Country:US
Practice Address - Phone:540-636-8770
Practice Address - Fax:540-636-8771
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350000682Medicare ID - Type Unspecified
VAU54487Medicare UPIN