Active NPI
Tanae Berg, DC
- Nutrition Chiropractor
- Stone Lake, WI
National Provider Identifier
1902428006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Chiropractor
- License
- 5736-12
- Practice address
- 5862N Highway 70
Stone Lake, WI 54876-8939 - Phone
- (715) 205-5560
- NPI assigned
- May 12, 2020
- Last updated
- Nov 6, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Chiropractor | 111NN1001X | 5736-12 | WI | Primary |
Addresses
Primary practice location
5862N Highway 70
Stone Lake, WI 54876-8939
Mailing address
2357 County Road SS
Rice Lake, WI 54868-9314
Phone (715) 205-5560
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5736-12 | WI | MD | Nutrition Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakelife Integrative Health | Chiropractor | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Chiropractor
- Stone Lake, WI
- NPI 1548068869
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699228800000",
"number": "1902428006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2357 COUNTY ROAD SS",
"city": "RICE LAKE",
"state": "WI",
"postal_code": "548689314",
"telephone_number": "715-205-5560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5862N HIGHWAY 70",
"city": "STONE LAKE",
"state": "WI",
"postal_code": "548768939",
"telephone_number": "715-205-5560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "TANAE",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-12",
"last_updated": "2023-11-06",
"certification_date": "2023-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "111NN1001X",
"taxonomy_group": "",
"desc": "Chiropractor, Nutrition",
"state": "WI",
"license": "5736-12",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stone Lake, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.