Provider Demographics
NPI:1508987595
Name:LEROY R PERRY JR DC A CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:LEROY R PERRY JR DC A CHIROPRACTIC CORPORATION
Other - Org Name:I.S.I.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:310-559-6900
Mailing Address - Street 1:3283 MOTOR AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3709
Mailing Address - Country:US
Mailing Address - Phone:310-559-6900
Mailing Address - Fax:310-836-8664
Practice Address - Street 1:3283 MOTOR AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3709
Practice Address - Country:US
Practice Address - Phone:310-559-6900
Practice Address - Fax:310-836-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ91851ZOtherBC BS NUMBER
CAWDC7695Medicare ID - Type UnspecifiedGROUP NUMBER