Provider Demographics
NPI:1699840603
Name:PERILLO, JASON CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHARLES
Last Name:PERILLO
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:PO BOX 20704
Mailing Address - Street 2:
Mailing Address - City:LEHIGH VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18002-0704
Mailing Address - Country:US
Mailing Address - Phone:610-317-9355
Mailing Address - Fax:610-317-9354
Practice Address - Street 1:2299 BRODHEAD RD STE A
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8990
Practice Address - Country:US
Practice Address - Phone:610-317-9355
Practice Address - Fax:610-317-9354
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9214111N00000X
PADC009889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX5B221Medicare ID - Type Unspecified