Provider Demographics
NPI:1629067806
Name:BERRY, TREVOR SEAN (DC, DACNB)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:SEAN
Last Name:BERRY
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 E WARNER RD
Mailing Address - Street 2:STE. A17
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-4558
Mailing Address - Country:US
Mailing Address - Phone:480-756-2600
Mailing Address - Fax:480-756-2530
Practice Address - Street 1:1761 E WARNER RD
Practice Address - Street 2:STE. A17
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-4558
Practice Address - Country:US
Practice Address - Phone:480-756-2600
Practice Address - Fax:480-756-2530
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5648111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ 0243810OtherBCBS OF AZ
AZ28071104OtherWORKERS COMP.
AZ641432OtherUNITED HEALTH CARE
AZAZ 0243810OtherBCBS OF AZ
AZU64224Medicare UPIN