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General NPI Number Information
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NPI Number | 1447963368
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Entity Type | Individual
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Provider Name | ALI LASHAN BERRY DC
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Gender | Male
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 280 S STATE ROAD 434 STE 1049
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-3859
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Country | US
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Telephone | 407-434-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 ENCORE PL APT 142
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City | LAKE MARY
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State | FL
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Zip | 32746-5628
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Country | US
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Telephone | 706-224-6653
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH14342
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License Number State | FL
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