Provider Demographics
NPI:1376397588
Name:PEREZ SOTO, MARIELY (DC)
Entity Type:Individual
Prefix:
First Name:MARIELY
Middle Name:
Last Name:PEREZ SOTO
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 1:6859 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4383
Mailing Address - Country:US
Mailing Address - Phone:704-275-5477
Mailing Address - Fax:980-819-9722
Practice Address - Street 1:6859 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-4383
Practice Address - Country:US
Practice Address - Phone:704-275-5477
Practice Address - Fax:980-819-9722
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor