Provider Demographics
NPI:1093952533
Name:BERRY MASSAGETHERAPY & CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:BERRY MASSAGETHERAPY & CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROMUSCULAR MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GLASS
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:NMT
Authorized Official - Phone:843-899-9088
Mailing Address - Street 1:202 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3785
Mailing Address - Country:US
Mailing Address - Phone:843-899-9088
Mailing Address - Fax:843-899-9088
Practice Address - Street 1:202 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3785
Practice Address - Country:US
Practice Address - Phone:843-899-9088
Practice Address - Fax:843-899-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty