Provider Demographics
NPI:1184752719
Name:JUSTIN CLIVE PERISH, D C
Entity type:Organization
Organization Name:JUSTIN CLIVE PERISH, D C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:CLIVE
Authorized Official - Last Name:PERISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-698-8933
Mailing Address - Street 1:3600 GUS THOMASSON RD
Mailing Address - Street 2:STE 146
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6200
Mailing Address - Country:US
Mailing Address - Phone:972-698-8933
Mailing Address - Fax:972-698-8934
Practice Address - Street 1:3600 GUS THOMASSON RD
Practice Address - Street 2:STE 146
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6200
Practice Address - Country:US
Practice Address - Phone:972-698-8933
Practice Address - Fax:972-698-8934
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEQUEST FAMILY CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-02
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088418103Medicaid
TX613031Medicare PIN
TX00756KMedicare ID - Type Unspecified
TX088418103Medicaid