Provider Demographics
NPI:1508977679
Name:LANA PERKINS RN BS DC PA
Entity Type:Organization
Organization Name:LANA PERKINS RN BS DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-936-2311
Mailing Address - Street 1:11470 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:239-936-2311
Mailing Address - Fax:239-936-7391
Practice Address - Street 1:11470 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907
Practice Address - Country:US
Practice Address - Phone:239-936-2311
Practice Address - Fax:239-936-7391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70839OtherBCBS
FL70839OtherBCBS
FL72806Medicare ID - Type Unspecified