Provider Demographics
NPI:1386785483
Name:BERRY, LINDA (DC)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:710 C ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3857
Mailing Address - Country:US
Mailing Address - Phone:415-847-3755
Mailing Address - Fax:
Practice Address - Street 1:916 SAN PABLO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2059
Practice Address - Country:US
Practice Address - Phone:415-847-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14314111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0143140Medicare ID - Type Unspecified
CADC0143140Medicare PIN