Provider Demographics
NPI:1073856621
Name:PERRY, EVAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:J
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 1:997 N CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9375
Mailing Address - Country:US
Mailing Address - Phone:989-732-2225
Mailing Address - Fax:989-731-6776
Practice Address - Street 1:997 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9375
Practice Address - Country:US
Practice Address - Phone:989-732-2225
Practice Address - Fax:989-731-6776
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor