Provider Demographics
NPI:1215302500
Name:PERRITON CHIROPRACTIC LLC
Entity type:Organization
Organization Name:PERRITON CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-941-0209
Mailing Address - Street 1:101 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-2934
Mailing Address - Country:US
Mailing Address - Phone:972-347-4138
Mailing Address - Fax:972-347-3866
Practice Address - Street 1:101 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2934
Practice Address - Country:US
Practice Address - Phone:972-347-4138
Practice Address - Fax:972-347-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty