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General NPI Number Information
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NPI Number | 1407042781
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Entity Type | Organization
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Legal Business Name | VILLAGE CHIROPRACTIC CENTER OF
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 425 W TOWN PL STE. 118
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-3661
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Country | US
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Telephone | 904-940-0361
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Fax | 904-940-0364
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Provider Business Mailing Address
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Address Line | 425 W TOWN PL STE. 118
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-3661
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Country | US
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Telephone | 904-940-0361
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Fax | 904-940-0364
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH LAYNE BERRY
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Credential | D.C.
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Telephone | 904-940-0361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH9346
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License Number State | FL
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