Healthcare Provider Details

I. General information

NPI: 1851686802
Provider Name (Legal Business Name): DOUGLAS MATTHEW PERRY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 EASTERN AVE
AUGUSTA ME
04330-5829
US

IV. Provider business mailing address

66 EASTERN AVE
AUGUSTA ME
04330-5829
US

V. Phone/Fax

Practice location:
  • Phone: 207-620-8291
  • Fax: 207-620-8292
Mailing address:
  • Phone: 207-620-8291
  • Fax: 207-620-8292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCR2015
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR2015
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: