Provider Demographics
NPI:1871699777
Name:PEREZ, LUIS ALBERTO (DC)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ALBERTO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BROADWAY ST
Mailing Address - Street 2:# B
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-3042
Mailing Address - Country:US
Mailing Address - Phone:620-285-6600
Mailing Address - Fax:620-285-6600
Practice Address - Street 1:313 W 14TH
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550
Practice Address - Country:US
Practice Address - Phone:620-285-6600
Practice Address - Fax:620-285-6600
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062150OtherBCBS
KS062150OtherBCBS
U83490Medicare UPIN