Provider Demographics
NPI:1891881272
Name:PERREY, DWIGHT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:
Last Name:PERREY
Suffix:JR
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 1:8509 HIXSON PIKE STE D
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5922
Mailing Address - Country:US
Mailing Address - Phone:423-432-6691
Mailing Address - Fax:423-332-9994
Practice Address - Street 1:8509 HIXSON PIKE STE D
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5922
Practice Address - Country:US
Practice Address - Phone:423-432-6691
Practice Address - Fax:423-332-9994
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT74853Medicare UPIN
TN3973613Medicare ID - Type Unspecified