Provider Demographics
NPI:1003139692
Name:BERRY, SUSAN NEELY (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:NEELY
Last Name:BERRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 FLOWOOD DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9019
Mailing Address - Country:US
Mailing Address - Phone:601-932-9201
Mailing Address - Fax:
Practice Address - Street 1:2470 FLOWOOD DR
Practice Address - Street 2:SUITE 125
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9019
Practice Address - Country:US
Practice Address - Phone:601-932-9201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor