Provider Demographics
NPI:1922287093
Name:BYRON L. PERRY DC PC INC
Entity Type:Organization
Organization Name:BYRON L. PERRY DC PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-434-0803
Mailing Address - Street 1:111 E CANAL AVE
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2111
Mailing Address - Country:US
Mailing Address - Phone:815-434-0803
Mailing Address - Fax:815-434-0772
Practice Address - Street 1:111 E CANAL AVE
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2111
Practice Address - Country:US
Practice Address - Phone:815-434-0803
Practice Address - Fax:815-434-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213317Medicare PIN