Provider Demographics
NPI:1760726590
Name:PERKINS, KRYSTAL ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:ROSE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8560 W OLYMPIC BLVD
Mailing Address - Street 2:# 119
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2051
Mailing Address - Country:US
Mailing Address - Phone:310-339-0255
Mailing Address - Fax:
Practice Address - Street 1:8730 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4547
Practice Address - Country:US
Practice Address - Phone:310-652-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor