Provider Demographics
NPI:1730270869
Name:BERBENICK, EUGENE FRANCIS (DC)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:FRANCIS
Last Name:BERBENICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:EUGENE
Other - Middle Name:FRANCIS
Other - Last Name:BERBENICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:5427 PACES MILL RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-6853
Mailing Address - Country:US
Mailing Address - Phone:229-221-5639
Mailing Address - Fax:
Practice Address - Street 1:327 E JACKSON ST STE B
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5175
Practice Address - Country:US
Practice Address - Phone:229-227-0026
Practice Address - Fax:229-227-1523
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000845919AMedicaid
GAU17307Medicare UPIN
GA35ZCCVDMedicare PIN