Provider Demographics
NPI:1952609364
Name:PEREMYD HEALTHCARE
Entity Type:Organization
Organization Name:PEREMYD HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATING DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-942-8100
Mailing Address - Street 1:329 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-6505
Mailing Address - Country:US
Mailing Address - Phone:972-942-8100
Mailing Address - Fax:214-942-8100
Practice Address - Street 1:329 CENTRE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6505
Practice Address - Country:US
Practice Address - Phone:972-942-8100
Practice Address - Fax:214-942-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty