Provider Demographics
NPI:1073792065
Name:ROBERT D BERRY, DC, INC
Entity Type:Organization
Organization Name:ROBERT D BERRY, DC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-994-5551
Mailing Address - Street 1:2863 COUNTY ROAD 529
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44842-9202
Mailing Address - Country:US
Mailing Address - Phone:419-994-5551
Mailing Address - Fax:419-994-5552
Practice Address - Street 1:2863 COUNTY ROAD 529
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:OH
Practice Address - Zip Code:44842-9202
Practice Address - Country:US
Practice Address - Phone:419-994-5551
Practice Address - Fax:419-994-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9353351Medicare PIN