Provider Demographics
NPI:1518977594
Name:BERRY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:BERRY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-994-1993
Mailing Address - Street 1:2515 WATERFORD PL
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1044
Mailing Address - Country:US
Mailing Address - Phone:205-994-1993
Mailing Address - Fax:205-639-1441
Practice Address - Street 1:1580 MONTGOMERY HWY
Practice Address - Street 2:14
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-4586
Practice Address - Country:US
Practice Address - Phone:205-533-8972
Practice Address - Fax:205-639-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALV11188Medicare UPIN