Provider Demographics
NPI:1609904630
Name:PERRY, MICHEL BRENT (DC, ACP)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:BRENT
Last Name:PERRY
Suffix:
Gender:M
Credentials:DC, ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 CENTRAL PKWY N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5052
Mailing Address - Country:US
Mailing Address - Phone:800-404-6050
Mailing Address - Fax:
Practice Address - Street 1:2810 OAK RUN PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4757
Practice Address - Country:US
Practice Address - Phone:800-404-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9763111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV02763Medicare UPIN