Provider Demographics
NPI:1932364080
Name:PERKINS CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:PERKINS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-866-4145
Mailing Address - Street 1:1031 N CULLEN ST
Mailing Address - Street 2:P.O. BOX 262
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-2007
Mailing Address - Country:US
Mailing Address - Phone:219-866-4145
Mailing Address - Fax:
Practice Address - Street 1:1031 N CULLEN ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-2007
Practice Address - Country:US
Practice Address - Phone:219-866-4145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0800506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100052990Medicaid
INT35066Medicare UPIN
IN100052990Medicaid