Provider Demographics
NPI:1457554867
Name:BERRY, DENNIS GORDON (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:GORDON
Last Name:BERRY
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 1:26 E MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1957
Mailing Address - Country:US
Mailing Address - Phone:509-520-2558
Mailing Address - Fax:
Practice Address - Street 1:26 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1957
Practice Address - Country:US
Practice Address - Phone:509-520-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor