MEDICARE: GREG JOHN PEROFF D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	GP008365	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	137247	OTHER	MI	CARE CHOICES
2	11214170	OTHER	MI	CAQH
3	0H11203	OTHER	MI	BCN

General Provider Information

NPI Number	:	1467484634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREG JOHN PEROFF D.C.

Provider Business Mailing Address
First Line	:	7320 ERNST RD
Second Line	:
City	:	MANCHESTER
State	:	MI
Zip	:	48158-9549
Country	:	US
Telephone Number	:	734-428-0165
Fax Number	:

Provider Business Practice Location Address
First Line	:	4347 JACKSON RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-1831
Country	:	US
Telephone Number	:	734-662-4000
Fax Number	:	734-662-2182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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Directions to “ GREG JOHN PEROFF D.C.” Practice Location

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