Provider Demographics
NPI:1144792094
Name:PERKINS, OTIS LEE II (DC)
Entity Type:Individual
Prefix:DR
First Name:OTIS
Middle Name:LEE
Last Name:PERKINS
Suffix:II
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 1:155 W A ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4516
Mailing Address - Country:US
Mailing Address - Phone:541-747-4555
Mailing Address - Fax:
Practice Address - Street 1:155 W A ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4516
Practice Address - Country:US
Practice Address - Phone:541-747-4555
Practice Address - Fax:541-747-4222
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor