Provider Demographics
NPI:1730650466
Name:PERRINO, VINCENT JAMES (DC)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:JAMES
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?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty