Provider Demographics
NPI:1770794257
Name:BERRY, TERESA JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:JEAN
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 1:2300 N RAINBOW BLVD
Mailing Address - Street 2:#122
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-7350
Mailing Address - Country:US
Mailing Address - Phone:702-259-0233
Mailing Address - Fax:702-259-0148
Practice Address - Street 1:2300 N RAINBOW BLVD
Practice Address - Street 2:#122
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-7350
Practice Address - Country:US
Practice Address - Phone:702-259-0233
Practice Address - Fax:702-259-0148
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDC489Medicare UPIN