Provider Demographics
NPI:1891977336
Name:BERRY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:BERRY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:508-755-6753
Mailing Address - Street 1:16 CLEWS ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-6209
Mailing Address - Country:US
Mailing Address - Phone:508-755-6753
Mailing Address - Fax:508-756-6533
Practice Address - Street 1:16 CLEWS ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-6209
Practice Address - Country:US
Practice Address - Phone:508-755-6753
Practice Address - Fax:508-756-6533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABEY39555OtherBCBS