Individual
DR. PHILIP GEORGE BERENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
125 SAINT MARY DR, PORT SANILAC, MI 48469-9656
(810) 622-8202
Mailing address
3850 MCKINLEY ST, DEARBORN, MI 48124-3674
(313) 562-4919
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301004763
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11271830
(CAQH)
MI
01
—
950G6511
BLUE CROSS BLUE SHIELD
MI
Enumeration date
05/01/2007
Last updated
07/08/2007
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