MEDICARE: DR. ROBERT D. BERRY D.C.

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	111NS0005X	Sports Physician Chiropractor	931	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	341821965-00	OTHER	OH	OHIO BWC #

General Provider Information

NPI Number	:	1598761371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT D. BERRY D.C.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	07/08/2007

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