1437331311 NPI number — BERRY CHIROPRACTIC CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437331311 NPI number — BERRY CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERRY CHIROPRACTIC CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437331311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 THOMAS JOHNSON DR
Provider Second Line Business Mailing Address:
#204
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21702-4410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-620-4100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
176 THOMAS JOHNSON DR
Provider Second Line Business Practice Location Address:
#204
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-620-4100
Provider Business Practice Location Address Fax Number:
301-420-1407
Provider Enumeration Date:
12/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BERRY
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
BLAKE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-620-4100

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  S01420 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: KP25BE . This is a "CAREFIRST BCBS MARYLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3831919 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223239 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: W375-0001 . This is a "CAREFIRST BCBS FEP" identifier . This identifiers is of the category "OTHER".




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