Provider Demographics
NPI:1366588584
Name:BERKEBILE, LYNN BARRY (DC)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:BARRY
Last Name:BERKEBILE
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 1:128 5TH AVE W
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-1202
Mailing Address - Country:US
Mailing Address - Phone:208-934-4107
Mailing Address - Fax:208-934-4107
Practice Address - Street 1:128 5TH AVE W
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-1202
Practice Address - Country:US
Practice Address - Phone:208-934-4107
Practice Address - Fax:208-934-4107
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC-364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC-2243OtherBLUE CROSS
ID00001-0009038OtherBLUE SHIELD
ID00001-0009038OtherBLUE SHIELD