Provider Demographics
NPI:1578501557
Name:PERETTI, ROBERT F (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:PERETTI
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:P.O BOX 141521
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75014-1521
Mailing Address - Country:US
Mailing Address - Phone:972-249-6087
Mailing Address - Fax:
Practice Address - Street 1:330 LAS COLINAS BLVD E
Practice Address - Street 2:SUITE 422
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-5510
Practice Address - Country:US
Practice Address - Phone:972-249-6087
Practice Address - Fax:972-409-2988
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W1170OtherBLUE CROSS BLUE SHIELD
TX8F3634Medicare PIN
TX8W1170OtherBLUE CROSS BLUE SHIELD