Provider Demographics
NPI:1457405227
Name:PEREA, JOHN MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MATTHEW
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 1:2210 CARSON AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-3223
Mailing Address - Country:US
Mailing Address - Phone:303-842-3972
Mailing Address - Fax:303-692-8805
Practice Address - Street 1:6265 E EVANS AVE
Practice Address - Street 2:SUITE. 7
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5817
Practice Address - Country:US
Practice Address - Phone:303-692-8803
Practice Address - Fax:303-692-8805
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor