Provider Demographics
NPI:1497860407
Name:PERKINS, KENNETH MACK (DC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:MACK
Last Name:PERKINS
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:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305-2705
Mailing Address - Country:US
Mailing Address - Phone:936-539-9299
Mailing Address - Fax:936-539-9298
Practice Address - Street 1:701 OLD MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301
Practice Address - Country:US
Practice Address - Phone:936-539-9299
Practice Address - Fax:936-539-9298
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088350601Medicaid
TX600849Medicare ID - Type Unspecified