MEDICARE: DR. JOHN MATTHEW PEREA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5819	CO

General Provider Information

NPI Number	:	1457405227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MATTHEW PEREA D.C.

Provider Business Mailing Address
First Line	:	2210 CARSON AVE
Second Line	:
City	:	LA JUNTA
State	:	CO
Zip	:	81050-3223
Country	:	US
Telephone Number	:	303-842-3972
Fax Number	:	303-692-8805

Provider Business Practice Location Address
First Line	:	6265 E EVANS AVE
Second Line	:	SUITE. 7
City	:	DENVER
State	:	CO
Zip	:	80222-5817
Country	:	US
Telephone Number	:	303-692-8803
Fax Number	:	303-692-8805

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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