Provider Demographics
NPI:1871801142
Name:PERRETTA HOLISITE SERVICES INC.
Entity type:Organization
Organization Name:PERRETTA HOLISITE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-821-9776
Mailing Address - Street 1:10000 WATSON RD STE 2L-12
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1854
Mailing Address - Country:US
Mailing Address - Phone:314-821-9776
Mailing Address - Fax:
Practice Address - Street 1:10000 WATSON RD STE 2L-12
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1854
Practice Address - Country:US
Practice Address - Phone:314-821-9776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR LOUIS A PERRETTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-20
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001003451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000031872Medicare UPIN