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General NPI Number Information
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NPI Number | 1902083967
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Entity Type | Organization
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Legal Business Name | BERRY CHIROPRACTIC PA
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 137 W 1ST ST
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City | WACONIA
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State | MN
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Zip | 55387-1190
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Country | US
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Telephone | 952-442-4555
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Fax | 952-442-4555
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Provider Business Mailing Address
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Address Line | 137 W 1ST ST
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City | WACONIA
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State | MN
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Zip | 55387-1190
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Country | US
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Telephone | 952-442-4555
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Fax | 952-442-4555
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CALE ALLAN BERRY
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Credential | D.C.
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Telephone | 952-442-4555
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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 | 4368
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License Number State | MN
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