Provider Demographics
NPI:1902428006
Name:BERG, TANAE (DC)
Entity Type:Individual
Prefix:DR
First Name:TANAE
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2357 COUNTY ROAD SS
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-9314
Mailing Address - Country:US
Mailing Address - Phone:715-205-5560
Mailing Address - Fax:
Practice Address - Street 1:5862N HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:STONE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54876-8939
Practice Address - Country:US
Practice Address - Phone:715-205-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5736-12111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition