Provider Demographics
NPI:1952382004
Name:BERRY, DONALD BLAKE (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:BLAKE
Last Name:BERRY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 SOLAREX CT
Mailing Address - Street 2:UNIT 205
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8655
Mailing Address - Country:US
Mailing Address - Phone:301-620-4100
Mailing Address - Fax:301-620-1407
Practice Address - Street 1:176 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 204
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4410
Practice Address - Country:US
Practice Address - Phone:301-620-4100
Practice Address - Fax:301-620-1407
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKP25BEOtherCAREFIRST BCBS MARYLAND
W375-0001OtherCAREFIRST BCBS FEP
3831919OtherCIGNA
223239OtherMAMSI
MDKP25BEOtherCAREFIRST BCBS MARYLAND