MEDICARE: DR. LISA M. BERRY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH 5216	FL
2	111N00000X	Chiropractor	CHIROO8454	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650319614	OTHER	FL	EMI /ECN INSURANCE

General Provider Information

NPI Number	:	1891799219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA M. BERRY D.C.

Provider Business Mailing Address
First Line	:	235 KINGS MILL CT
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-4940
Country	:	US
Telephone Number	:	678-682-3988
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 KINGS MILL CT
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-4940
Country	:	US
Telephone Number	:	678-682-3988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/05/2009

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