Provider Demographics
NPI:1962705954
Name:PERRI, CHRISTINA ADA (LAC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ADA
Last Name:PERRI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 11TH PL
Mailing Address - Street 2:UNIT 103
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-1198
Mailing Address - Country:US
Mailing Address - Phone:262-748-7750
Mailing Address - Fax:
Practice Address - Street 1:5603 7TH AVENUE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-1198
Practice Address - Country:US
Practice Address - Phone:262-358-0991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI642-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist