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NPI Code Detail

MEDICARE: DR. LISA M. BERRY D.C.

MEDICARE:  DR. LISA M. 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
1111N00000XChiropractorCH 5216FL
2111N00000XChiropractorCHIROO8454GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1650319614OTHERFLEMI /ECN INSURANCE

General Provider Information

NPI Number : 1891799219
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA M. BERRY D.C.
Provider Business Mailing Address
First Line : 235 KINGS MILL CT
Second Line :
City : ROSWELL
State : GA
Zip : 30075-4940
Country : US
Telephone Number : 678-682-3988
Fax Number :
Provider Business Practice Location Address
First Line : 235 KINGS MILL CT
Second Line :
City : ROSWELL
State : GA
Zip : 30075-4940
Country : US
Telephone Number : 678-682-3988
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 10/05/2009

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Directions to “ DR. LISA M. BERRY D.C.” Practice Location

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