Provider Demographics
NPI:1629394739
Name:PERRINO, NICHOLAS ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:PERRINO
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 1:3401 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5978
Mailing Address - Country:US
Mailing Address - Phone:607-239-5494
Mailing Address - Fax:607-239-6275
Practice Address - Street 1:3401 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-5978
Practice Address - Country:US
Practice Address - Phone:607-239-5494
Practice Address - Fax:607-239-6275
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0118571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor