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General NPI Number Information
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NPI Number | 1437331311
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Entity Type | Organization
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Legal Business Name | BERRY CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 176 THOMAS JOHNSON DR #204
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City | FREDERICK
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State | MD
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Zip | 21702-4410
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Country | US
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Telephone | 301-620-4100
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Fax | 301-420-1407
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Provider Business Mailing Address
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Address Line | 176 THOMAS JOHNSON DR #204
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City | FREDERICK
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State | MD
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Zip | 21702-4410
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Country | US
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Telephone | 301-620-4100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DONALD BLAKE BERRY
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Credential | DC
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Telephone | 301-620-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | S01420
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License Number State | MD
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