Provider Demographics
NPI:1104911833
Name:LEEANN BERARD
Entity type:Organization
Organization Name:LEEANN BERARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-753-0503
Mailing Address - Street 1:124 RUSSELL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1910
Mailing Address - Country:US
Mailing Address - Phone:508-753-0503
Mailing Address - Fax:508-757-1922
Practice Address - Street 1:124 RUSSELL ST
Practice Address - Street 2:SUITE A
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1910
Practice Address - Country:US
Practice Address - Phone:508-753-0503
Practice Address - Fax:508-757-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty