Provider Demographics
NPI:1346386851
Name:BERRY, DOUGLAS DAVID JR (DC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:DAVID
Last Name:BERRY
Suffix:JR
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 IINI WAY
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-7906
Mailing Address - Country:US
Mailing Address - Phone:253-209-9725
Mailing Address - Fax:808-727-2211
Practice Address - Street 1:1280 S KIHEI RD APT 121
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-5296
Practice Address - Country:US
Practice Address - Phone:808-727-2121
Practice Address - Fax:087-272-2118
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC1577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0143825OtherL&I
WAU94550Medicare UPIN
WA8852712Medicare ID - Type Unspecified