Provider Demographics
NPI:1376978205
Name:BERRY FARMS CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:BERRY FARMS CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:731-446-7003
Mailing Address - Street 1:4000 HUGHES CROSSING
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5044
Mailing Address - Country:US
Mailing Address - Phone:731-446-7003
Mailing Address - Fax:
Practice Address - Street 1:4000 HUGHES CROSSING
Practice Address - Street 2:SUITE 140
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-5044
Practice Address - Country:US
Practice Address - Phone:731-446-7003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN113610OtherCIGNA
TN3972788OtherPTAN
TN4356483OtherGROUP BLUE CROSS BLUE SHIELD
TN1515991Medicaid
TN4043017OtherBLUE CROSS BLUE SHIELD
TN4356483OtherGROUP BLUE CROSS BLUE SHIELD