Provider Demographics
NPI:1326109968
Name:PERRON, GREGORY PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PETER
Last Name:PERRON
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 1:990 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356
Mailing Address - Country:US
Mailing Address - Phone:508-588-1300
Mailing Address - Fax:508-588-3313
Practice Address - Street 1:990 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02356
Practice Address - Country:US
Practice Address - Phone:508-588-1300
Practice Address - Fax:508-588-3313
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
303841OtherTHFTS
MA9782753Medicaid
Y39126OtherBCBS
Y39126Medicare ID - Type Unspecified
MA9782753Medicaid