Healthcare Provider Details

I. General information

NPI: 1235213927
Provider Name (Legal Business Name): MARK ALAN PERLMUTTER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 LITTLE LAKE DR SUITE 8
ANN ARBOR MI
48103-6218
US

IV. Provider business mailing address

210 LITTLE LAKE DR SUITE 8
ANN ARBOR MI
48103-6218
US

V. Phone/Fax

Practice location:
  • Phone: 734-761-5908
  • Fax: 734-761-5928
Mailing address:
  • Phone: 734-761-5908
  • Fax: 734-761-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007524
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: