MEDICARE: ROBERT D BERRY, DC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	931	OH

General Provider Information

NPI Number	:	1073792065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT D BERRY, DC, INC

Provider Business Mailing Address
First Line	:	2863 COUNTY ROAD 529
Second Line	:
City	:	LOUDONVILLE
State	:	OH
Zip	:	44842-9202
Country	:	US
Telephone Number	:	419-994-5551
Fax Number	:	419-994-5552

Provider Business Practice Location Address
First Line	:	2863 COUNTY ROAD 529
Second Line	:
City	:	LOUDONVILLE
State	:	OH
Zip	:	44842-9202
Country	:	US
Telephone Number	:	419-994-5551
Fax Number	:	419-994-5552

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	DR. ROBERT D BERRY
Credential	:	D.C.
Telephone Number	:	419-994-5551

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	10/26/2007

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