Provider Demographics
NPI:1447963368
Name:BERRY, ALI LASHAN (DC)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:LASHAN
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 1:1400 ENCORE PL APT 142
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5628
Mailing Address - Country:US
Mailing Address - Phone:706-224-6653
Mailing Address - Fax:
Practice Address - Street 1:280 S STATE ROAD 434 STE 1049
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3859
Practice Address - Country:US
Practice Address - Phone:407-434-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor