Healthcare Provider Details

I. General information

NPI: 1205073046
Provider Name (Legal Business Name): PERRY CHIROPRACTIC & ACUPUNCTURE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 03/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 ILLINOIS AVE
ST CHARLES IL
60174-2100
US

IV. Provider business mailing address

511 ILLINOIS AVE
ST CHARLES IL
60174-2100
US

V. Phone/Fax

Practice location:
  • Phone: 630-444-1490
  • Fax: 630-444-1491
Mailing address:
  • Phone: 630-444-1490
  • Fax: 630-444-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. GALE ANN PERRY
Title or Position: MANAGER
Credential: D.C,
Phone: 630-444-1490