Healthcare Provider Details

I. General information

NPI: 1134386501
Provider Name (Legal Business Name): ELIZABETH PEREZ D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2261 BLUESTONE DR
SAINT CHARLES MO
63303-6705
US

IV. Provider business mailing address

2261 BLUESTONE DR
SAINT CHARLES MO
63303-6705
US

V. Phone/Fax

Practice location:
  • Phone: 314-422-4853
  • Fax:
Mailing address:
  • Phone: 636-724-9444
  • Fax: 636-724-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2008011985
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: