Healthcare Provider Details

I. General information

NPI: 1629067806
Provider Name (Legal Business Name): TREVOR SEAN BERRY D.C., D.A.C.N.B.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 E WARNER RD STE. A17
TEMPE AZ
85284-4558
US

IV. Provider business mailing address

1761 E WARNER RD STE. A17
TEMPE AZ
85284-4558
US

V. Phone/Fax

Practice location:
  • Phone: 480-756-2600
  • Fax: 480-756-2530
Mailing address:
  • Phone: 480-756-2600
  • Fax: 480-756-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number5648
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: