MEDICARE: MS. PERI LYNN DWYER DC DICCP

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	CH5646	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CH5646	OTHER	FL	STATE LICENSE
3	22143	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1871628743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PERI LYNN DWYER DC DICCP

Provider Business Mailing Address
First Line	:	2819 MAHAN DR
Second Line	:	SUITE 102
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5491
Country	:	US
Telephone Number	:	850-877-8980
Fax Number	:	850-671-1796

Provider Business Practice Location Address
First Line	:	2819 MAHAN DR
Second Line	:	SUITE 102
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5491
Country	:	US
Telephone Number	:	850-877-8980
Fax Number	:	850-671-1796

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	05/09/2008

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