Provider Demographics
NPI:1841494077
Name:BERRY, KENNETH LAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LAYNE
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 1:425 W TOWN PL
Mailing Address - Street 2:STE. 118
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3661
Mailing Address - Country:US
Mailing Address - Phone:904-940-0361
Mailing Address - Fax:904-940-0364
Practice Address - Street 1:425 W TOWN PL
Practice Address - Street 2:STE. 118
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3661
Practice Address - Country:US
Practice Address - Phone:904-940-0361
Practice Address - Fax:904-940-0364
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor