Provider Demographics
NPI:1902861875
Name:BERRY, EDWIN D II (DC)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:D
Last Name:BERRY
Suffix:II
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 1:16 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
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABEY35414OtherBC/BS
MAY35414Medicare PIN
MABEY35414OtherBC/BS