Provider Demographics
NPI:1073549119
Name:PERRY CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:PERRY CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-234-2064
Mailing Address - Street 1:847 SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6707
Mailing Address - Country:US
Mailing Address - Phone:337-234-2064
Mailing Address - Fax:337-234-9366
Practice Address - Street 1:847 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6707
Practice Address - Country:US
Practice Address - Phone:337-234-2064
Practice Address - Fax:337-234-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C860Medicare UPIN
LA5CJ40Medicare ID - Type Unspecified
LA4C672Medicare UPIN