Provider Demographics
NPI:1871610824
Name:PERRAS CHIROPRACTIC, PC
Entity type:Organization
Organization Name:PERRAS CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PERRAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-762-6326
Mailing Address - Street 1:104 S WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2420
Mailing Address - Country:US
Mailing Address - Phone:518-762-6326
Mailing Address - Fax:518-762-2786
Practice Address - Street 1:104 S WILLIAM ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2420
Practice Address - Country:US
Practice Address - Phone:518-762-6326
Practice Address - Fax:518-762-2786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0416Medicare PIN
NYT26767Medicare UPIN