Provider Demographics
NPI:1750456455
Name:BERRY, LEIGH C (DC)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:C
Last Name:BERRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2239
Mailing Address - Country:US
Mailing Address - Phone:607-936-7871
Mailing Address - Fax:607-936-7893
Practice Address - Street 1:56 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2239
Practice Address - Country:US
Practice Address - Phone:607-936-7871
Practice Address - Fax:607-936-7893
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009167-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO9167-1OtherWORKMANS COMP PROVIDER #
NYRB0056Medicare PIN