Provider Demographics
NPI:1447673504
Name:PERRY SPINE CENTER
Entity type:Organization
Organization Name:PERRY SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:ROSSI
Authorized Official - Last Name:FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:D,C,
Authorized Official - Phone:850-843-3494
Mailing Address - Street 1:721 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-4116
Mailing Address - Country:US
Mailing Address - Phone:850-843-3494
Mailing Address - Fax:954-697-0462
Practice Address - Street 1:721 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-4116
Practice Address - Country:US
Practice Address - Phone:850-843-3494
Practice Address - Fax:954-697-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008609400Medicaid