Provider Demographics
NPI:1265639355
Name:PERUGINI CHIROPRACTIC SC
Entity Type:Organization
Organization Name:PERUGINI CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:F
Authorized Official - Last Name:PERUGINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-363-9552
Mailing Address - Street 1:435 RIVERCREST CT
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1759
Mailing Address - Country:US
Mailing Address - Phone:262-363-9552
Mailing Address - Fax:262-363-9556
Practice Address - Street 1:435 RIVERCREST CT
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1759
Practice Address - Country:US
Practice Address - Phone:262-363-9552
Practice Address - Fax:262-363-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38972200Medicaid