Provider Demographics
NPI:1750118360
Name:PERAZA, ADOLFO (DC)
Entity type:Individual
Prefix:DR
First Name:ADOLFO
Middle Name:
Last Name:PERAZA
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 1:6829 BUSHNELL DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3738
Mailing Address - Country:US
Mailing Address - Phone:863-430-4341
Mailing Address - Fax:
Practice Address - Street 1:1509 S FLORIDA AVE STE 3
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2258
Practice Address - Country:US
Practice Address - Phone:863-616-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor