Provider Demographics
NPI:1871628743
Name:DWYER, PERI LYNN (DC DICCP)
Entity type:Individual
Prefix:MS
First Name:PERI
Middle Name:LYNN
Last Name:DWYER
Suffix:
Gender:F
Credentials:DC DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 MAHAN DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5491
Mailing Address - Country:US
Mailing Address - Phone:850-877-8980
Mailing Address - Fax:850-671-1796
Practice Address - Street 1:2819 MAHAN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5491
Practice Address - Country:US
Practice Address - Phone:850-877-8980
Practice Address - Fax:850-671-1796
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380166700Medicaid
FLCH5646OtherSTATE LICENSE
FL22143OtherBCBS
FLCH5646OtherSTATE LICENSE
22143ZMedicare ID - Type Unspecified