Provider Demographics
NPI:1538228531
Name:PEREZ, RUSSELL A (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:A
Last Name:PEREZ
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 1:8212 BREWERTON RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-6400
Mailing Address - Country:US
Mailing Address - Phone:315-699-1441
Mailing Address - Fax:315-699-2596
Practice Address - Street 1:8212 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-6400
Practice Address - Country:US
Practice Address - Phone:315-699-1441
Practice Address - Fax:315-699-2596
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009040-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor