Provider Demographics
NPI:1497853071
Name:CAMMISA, PERRY ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:ANTHONY
Last Name:CAMMISA
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 1:3590 HOBSON ROAD
Mailing Address - Street 2:STE 301
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517
Mailing Address - Country:US
Mailing Address - Phone:630-778-9000
Mailing Address - Fax:630-778-9065
Practice Address - Street 1:3590 HOBSON RD
Practice Address - Street 2:STE 301
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-5409
Practice Address - Country:US
Practice Address - Phone:630-778-9000
Practice Address - Fax:630-778-9065
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U18376Medicare UPIN
IL949350Medicare PIN