Provider Demographics
NPI:1023198173
Name:PERRY, STEVEN BRIAN (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRIAN
Last Name:PERRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18740 VENTURA BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3399
Mailing Address - Country:US
Mailing Address - Phone:818-881-2225
Mailing Address - Fax:818-881-0188
Practice Address - Street 1:18740 VENTURA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3399
Practice Address - Country:US
Practice Address - Phone:818-881-2225
Practice Address - Fax:818-881-0188
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC16021Medicare ID - Type Unspecified