Provider Demographics
NPI:1265464176
Name:PERRY, JENNIFER (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
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 1:837 WESTMORE MEYERS RD
Mailing Address - Street 2:SUITE A6-12
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3724
Mailing Address - Country:US
Mailing Address - Phone:630-932-1690
Mailing Address - Fax:630-932-4110
Practice Address - Street 1:837 WESTMORE MEYERS RD
Practice Address - Street 2:SUITE A6-12
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3724
Practice Address - Country:US
Practice Address - Phone:630-932-1690
Practice Address - Fax:630-932-4110
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK13977Medicare ID - Type UnspecifiedMEDICARE MEMBER NUMBER