Provider Demographics
NPI:1346386851
Name:BERRY, DOUGLAS DAVID JR (DC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:DAVID
Last Name:BERRY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18710 MERIDIAN E STE 116
Mailing Address - Street 2:
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 STE 116
Practice Address - Street 2:
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
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0143825OtherL&I
WAU94550Medicare UPIN
WA8852712Medicare ID - Type Unspecified