Provider Demographics
NPI:1710009212
Name:M. KATHLEEN PERRY DC, PLLC
Entity Type:Organization
Organization Name:M. KATHLEEN PERRY DC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:M.
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC PLLC
Authorized Official - Phone:817-930-0600
Mailing Address - Street 1:2510 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-1300
Mailing Address - Country:US
Mailing Address - Phone:817-930-0600
Mailing Address - Fax:817-451-1252
Practice Address - Street 1:2510 LITTLE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-1300
Practice Address - Country:US
Practice Address - Phone:817-930-0600
Practice Address - Fax:817-451-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0396Medicare PIN