Provider Demographics
NPI:1306048483
Name:TED H PERKINS P A
Entity type:Organization
Organization Name:TED H PERKINS P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:H
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-567-7777
Mailing Address - Street 1:780 US HIGHWAY 1
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-1660
Mailing Address - Country:US
Mailing Address - Phone:772-567-7777
Mailing Address - Fax:772-778-9382
Practice Address - Street 1:780 US HIGHWAY 1
Practice Address - Street 2:SUITE 201
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-1660
Practice Address - Country:US
Practice Address - Phone:772-567-7777
Practice Address - Fax:772-778-9382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40983OtherGROUP BCBS NUMBER
FL40983OtherGROUP BCBS NUMBER