Provider Demographics
NPI:1467484634
Name:PEROFF, GREG JOHN (DC)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:JOHN
Last Name:PEROFF
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 1:7320 ERNST RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48158-9549
Mailing Address - Country:US
Mailing Address - Phone:734-428-0165
Mailing Address - Fax:
Practice Address - Street 1:4347 JACKSON RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1831
Practice Address - Country:US
Practice Address - Phone:734-662-4000
Practice Address - Fax:734-662-2182
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGP008365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI137247OtherCARE CHOICES
MI11214170OtherCAQH
MI0H11203OtherBCN
MI0H11203OtherBCN
MIU89664Medicare UPIN