Provider Demographics
NPI:1083803266
Name:BERRY, KENNETH CHARLES III (LAC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CHARLES
Last Name:BERRY
Suffix:III
Gender:M
Credentials:LAC
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Mailing Address - Street 1:2131 CAPITOL AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5755
Mailing Address - Country:US
Mailing Address - Phone:916-444-2177
Mailing Address - Fax:415-329-4989
Practice Address - Street 1:2131 CAPITOL AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5755
Practice Address - Country:US
Practice Address - Phone:916-444-2177
Practice Address - Fax:415-329-4989
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2014-10-27
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Provider Licenses
StateLicense IDTaxonomies
CA11845171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist