Provider Demographics
NPI:1114138666
Name:PERRY SPINE & WELLNESS CENTER, LTD.
Entity Type:Organization
Organization Name:PERRY SPINE & WELLNESS CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-425-2225
Mailing Address - Street 1:402 TIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-5758
Mailing Address - Country:US
Mailing Address - Phone:419-425-2225
Mailing Address - Fax:419-425-2244
Practice Address - Street 1:402 TIFFIN AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-5758
Practice Address - Country:US
Practice Address - Phone:419-425-2225
Practice Address - Fax:419-425-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1699789065OtherINDIVIDUAL NPI
OH36792376300OtherBWC
OH36792376300OtherBWC
OHV07094Medicare UPIN