Provider Demographics
NPI:1497819007
Name:PERKINS, PHILLIP BRANDON (DC)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:BRANDON
Last Name:PERKINS
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 1:11470 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2323
Mailing Address - Country:US
Mailing Address - Phone:239-936-2311
Mailing Address - Fax:239-936-7391
Practice Address - Street 1:11470 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2323
Practice Address - Country:US
Practice Address - Phone:239-936-2311
Practice Address - Fax:239-936-7391
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53992Medicare ID - Type Unspecified