Provider Demographics
NPI:1366425084
Name:BURY, TROY M (DC)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:M
Last Name:BURY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 BOARDMAN-CANFIELD RD
Mailing Address - Street 2:STE 100C
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406
Mailing Address - Country:US
Mailing Address - Phone:330-702-5555
Mailing Address - Fax:330-702-0363
Practice Address - Street 1:4030 BOARDMAN-CANFIELD RD
Practice Address - Street 2:STE 100C
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406
Practice Address - Country:US
Practice Address - Phone:330-702-5555
Practice Address - Fax:330-702-0363
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2292933Medicaid
7172056OtherAETNA
4497335OtherUNITEDHEALTHCARE
341906188026OtherCARESOURCE
OH000000141917OtherANTHEM BC/BS
OH$$$$$$$$$001OtherMEDICAL MUTUAL OF OHIO
OH000000141917OtherANTHEM BC/BS
341906188026OtherCARESOURCE