Healthcare Provider Details

I. General information

NPI: 1821408832
Provider Name (Legal Business Name): TYELER CHASE BERRY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WILDEWOOD PARK DR SUITE B
COLUMBIA SC
29223-4319
US

IV. Provider business mailing address

101 WILDEWOOD PARK DR SUITE B
COLUMBIA SC
29223-4319
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-7890
  • Fax: 803-250-2581
Mailing address:
  • Phone: 803-788-7890
  • Fax: 803-250-2581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11194
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4184
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: