Provider Demographics
NPI:1003984220
Name:PERRY, ROBERT KARL (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KARL
Last Name:PERRY
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 1:4781 E HALFMOON DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-2817
Mailing Address - Country:US
Mailing Address - Phone:928-526-0435
Mailing Address - Fax:
Practice Address - Street 1:2530 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3719
Practice Address - Country:US
Practice Address - Phone:928-774-7165
Practice Address - Fax:928-774-7167
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor