Provider Demographics
NPI:1790159846
Name:BERRY, JAMES D (DACM)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:BERRY
Suffix:
Gender:M
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-0471
Mailing Address - Country:US
Mailing Address - Phone:406-309-3483
Mailing Address - Fax:
Practice Address - Street 1:149 MAIN ST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4451
Practice Address - Country:US
Practice Address - Phone:406-309-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCACUP248171100000X
MTMED-ACU-LIC-110532171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist