Provider Demographics
NPI:1679606297
Name:BERTHIAUME, DANA A (DC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:A
Last Name:BERTHIAUME
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 1:655 SOUTHPOINTE CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3859
Mailing Address - Country:US
Mailing Address - Phone:719-963-6044
Mailing Address - Fax:
Practice Address - Street 1:655 SOUTHPOINTE CT STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3859
Practice Address - Country:US
Practice Address - Phone:719-963-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007299111N00000X
COCHR.0007299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89304ZMedicare PIN