Provider Demographics
NPI:1295767127
Name:BERRY, LINDA SUSAN (DC)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUSAN
Last Name:BERRY
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4066 PROCEEDS DR
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-8251
Mailing Address - Country:US
Mailing Address - Phone:734-646-0664
Mailing Address - Fax:
Practice Address - Street 1:4066 PROCEEDS DR
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169-8251
Practice Address - Country:US
Practice Address - Phone:734-646-0664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILB005259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H112630OtherBCBS PIN
MILB005259OtherSTATE LICENSE #
MILB005259OtherSTATE LICENSE #
MIT33629Medicare UPIN