Provider Demographics
NPI:1851686802
Name:PERRY, DOUGLAS MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MATTHEW
Last Name:PERRY
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 1:66 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5829
Mailing Address - Country:US
Mailing Address - Phone:207-620-8291
Mailing Address - Fax:207-620-8292
Practice Address - Street 1:66 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5829
Practice Address - Country:US
Practice Address - Phone:207-620-8291
Practice Address - Fax:207-620-8292
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2015111NN1001X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition