Provider Demographics
NPI:1932122108
Name:BERRY, MARK NEAL (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:NEAL
Last Name:BERRY
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
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Mailing Address - Street 1:2515 WATERFORD PL
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1044
Mailing Address - Country:US
Mailing Address - Phone:205-994-1993
Mailing Address - Fax:205-639-1441
Practice Address - Street 1:1580 MONGOMERY HIGHWAY
Practice Address - Street 2:14
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-4586
Practice Address - Country:US
Practice Address - Phone:205-533-8972
Practice Address - Fax:205-639-1441
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL2158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALV11188Medicare UPIN