Provider Demographics
NPI:1891799219
Name:BERRY, LISA M (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:BERRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:BERRY-KLAUSMEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:235 KINGS MILL CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4940
Mailing Address - Country:US
Mailing Address - Phone:678-682-3988
Mailing Address - Fax:
Practice Address - Street 1:235 KINGS MILL CT
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4940
Practice Address - Country:US
Practice Address - Phone:678-682-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 5216111N00000X
GACHIROO8454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650319614OtherEMI /ECN INSURANCE
FL650319614OtherEMI /ECN INSURANCE
FLT84313Medicare UPIN