Provider Demographics
NPI:1124357157
Name:BERRY FAMILY CHIROPRACTIC PS
Entity Type:Organization
Organization Name:BERRY FAMILY CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:253-875-9464
Mailing Address - Street 1:18710 MERIDIAN E
Mailing Address - Street 2:SUITE 116
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2231
Mailing Address - Country:US
Mailing Address - Phone:253-875-9464
Mailing Address - Fax:253-875-9468
Practice Address - Street 1:18710 MERIDIAN E
Practice Address - Street 2:STE 116
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-2231
Practice Address - Country:US
Practice Address - Phone:253-875-9464
Practice Address - Fax:253-875-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty