Healthcare Provider Details

I. General information

NPI: 1962627141
Provider Name (Legal Business Name): RANDALL SCOTT PERRY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ARDEN WAY SUITE NUMBER 1A
SACRAMENTO CA
95825-2000
US

IV. Provider business mailing address

3000 ARDEN WAY SUITE NUMBER 1A
SACRAMENTO CA
95825-2000
US

V. Phone/Fax

Practice location:
  • Phone: 916-488-5560
  • Fax: 916-488-5597
Mailing address:
  • Phone: 916-488-5560
  • Fax: 916-488-5597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC19943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: