Provider Demographics
NPI:1518389345
Name:TAUTKUS-BERRY, ALYSIA (DC)
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:
Last Name:TAUTKUS-BERRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ALYSIA
Other - Middle Name:
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5690 SHAFFER RD
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3870
Mailing Address - Country:US
Mailing Address - Phone:814-375-6817
Mailing Address - Fax:
Practice Address - Street 1:5690 SHAFFER RD
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3870
Practice Address - Country:US
Practice Address - Phone:814-375-6817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor