Provider Demographics
NPI:1568891307
Name:PERRYVILLE HEALTH CENTER LLC
Entity Type:Organization
Organization Name:PERRYVILLE HEALTH CENTER LLC
Other - Org Name:PERRYVILLE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-547-8300
Mailing Address - Street 1:1304B BRENDA AVE
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-2303
Mailing Address - Country:US
Mailing Address - Phone:573-547-8300
Mailing Address - Fax:573-547-8329
Practice Address - Street 1:1304B BRENDA AVE
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-2303
Practice Address - Country:US
Practice Address - Phone:573-547-8300
Practice Address - Fax:573-547-8329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008003142111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty