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General NPI Number Information
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NPI Number | 1184871667
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Entity Type | Organization
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Legal Business Name | PERRY CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 305 N ORANGE ST
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City | PERRY
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State | FL
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Zip | 32347-2726
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Country | US
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Telephone | 850-584-7117
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Fax | 850-584-7119
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Provider Business Mailing Address
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Address Line | 305 N ORANGE ST
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City | PERRY
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State | FL
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Zip | 32347-2726
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Country | US
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Telephone | 850-584-7117
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Fax | 850-584-7119
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Authorized Official
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Title or Position | CEO
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Name | DR. LEE STEVEN NELSEN
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Credential | D.C.
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Telephone | 850-584-7117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CH4181
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License Number State | FL
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