Provider Demographics
NPI:1609098722
Name:BERRY, CASEY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:ALLEN
Last Name:BERRY
Suffix:
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 1:15219 REEDS ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3241
Mailing Address - Country:US
Mailing Address - Phone:816-309-3863
Mailing Address - Fax:
Practice Address - Street 1:4711 MISSION RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-1626
Practice Address - Country:US
Practice Address - Phone:913-432-5678
Practice Address - Fax:913-236-8726
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSW89F658Medicare PIN