Provider Demographics
NPI:1013026137
Name:PERIH, THEODORE EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:EDWARD
Last Name:PERIH
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 1:803 WEST BROAD STREET
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3108
Mailing Address - Country:US
Mailing Address - Phone:703-533-7707
Mailing Address - Fax:703-237-2839
Practice Address - Street 1:803 WEST BROAD ST
Practice Address - Street 2:SUITE 240
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3108
Practice Address - Country:US
Practice Address - Phone:703-533-7707
Practice Address - Fax:703-237-2839
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
017403OtherBCBS
T73501Medicare UPIN
075608Medicare ID - Type Unspecified