Provider Demographics
NPI:1720128127
Name:PERRY, KEVIN A (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:PERRY
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 1:45 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-3205
Mailing Address - Country:US
Mailing Address - Phone:508-697-1831
Mailing Address - Fax:
Practice Address - Street 1:63 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-1455
Practice Address - Country:US
Practice Address - Phone:508-697-0050
Practice Address - Fax:508-697-0882
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2182111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA21536OtherBMC HEALTHNET PLAN
MA792311OtherTUFTS
MA2990813OtherAETNA
MAY36559OtherBCBS INDIV. PROVIDER #
MA1612441Medicaid
MA0040379OtherNEIGHBORHOOD HEALTH PLAN
MA351229OtherHARVARD PILGRIM
MAPE745179Medicare ID - Type UnspecifiedINDIVIDUAL ID #
MA792311OtherTUFTS
MA1612441Medicaid