Provider Demographics
NPI:1023336203
Name:BERRY CHIROPRACTIC FAMILY AND SPORTS REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:BERRY CHIROPRACTIC FAMILY AND SPORTS REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:NEELY
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-843-9000
Mailing Address - Street 1:110 E END ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2742
Mailing Address - Country:US
Mailing Address - Phone:662-843-9000
Mailing Address - Fax:662-843-9003
Practice Address - Street 1:110 E END ST
Practice Address - Street 2:SUITE B
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2742
Practice Address - Country:US
Practice Address - Phone:662-843-9000
Practice Address - Fax:662-843-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty