Provider Demographics
NPI:1215939640
Name:PEROULAKIS, ANGELO
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:
Last Name:PEROULAKIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6479 S RACCOON RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9270
Mailing Address - Country:US
Mailing Address - Phone:330-533-6327
Mailing Address - Fax:330-533-0425
Practice Address - Street 1:6479 S RACCOON RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9270
Practice Address - Country:US
Practice Address - Phone:330-533-6327
Practice Address - Fax:330-533-0425
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000370053OtherANTHEM PROVIDER ID
OH2021270Medicaid
OH0818342Medicare ID - Type Unspecified
OH000000370053OtherANTHEM PROVIDER ID