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General NPI Number Information
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NPI Number | 1346477668
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Entity Type | Individual
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Provider Name | RONALD EUGENE PERRY D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 60 N MAIN ST
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City | MALAD CITY
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State | ID
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Zip | 83252-1200
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Country | US
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Telephone | 801-725-9669
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Fax | 801-298-4617
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | MALAD CITY
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State | ID
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Zip | 83252-0069
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Country | US
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Telephone | 801-725-9669
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Fax | 801-298-4617
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 27-0231581
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License Number State | ID
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