Provider Demographics
NPI:1003143470
Name:BERRY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BERRY CHIROPRACTIC PC
Other - Org Name:ALL STAR CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-942-6066
Mailing Address - Street 1:9738 WORNALL RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3905
Mailing Address - Country:US
Mailing Address - Phone:816-942-6066
Mailing Address - Fax:816-942-4773
Practice Address - Street 1:9738 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3905
Practice Address - Country:US
Practice Address - Phone:816-942-6066
Practice Address - Fax:816-942-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007025806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO111N00000XOtherCHIROPRACTIC