Provider Demographics
NPI:1417021965
Name:PEREA, BOBBY O (DC)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:O
Last Name:PEREA
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 1:444 SAINT MICHAELS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7620
Mailing Address - Country:US
Mailing Address - Phone:505-982-6886
Mailing Address - Fax:
Practice Address - Street 1:444 SAINT MICHAELS DR
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7620
Practice Address - Country:US
Practice Address - Phone:505-982-6886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM331429504Medicare ID - Type Unspecified
NMU85770Medicare UPIN