Basic Information
Provider Information
NPI: 1609904630
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PERRY
FirstName: MICHEL
MiddleName: BRENT
NamePrefix: DR.
NameSuffix:  
Credential: D.C., A.C.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 911 CENTRAL PKWY N
Address2: SUITE 300
City: SAN ANTONIO
State: TX
PostalCode: 782325052
CountryCode: US
TelephoneNumber: 8004046050
FaxNumber:  
Practice Location
Address1: 2810 OAK RUN PKWY
Address2: SUITE 100
City: NEW BRAUNFELS
State: TX
PostalCode: 781324757
CountryCode: US
TelephoneNumber: 8004046050
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/01/2007
LastUpdateDate: 08/11/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111NR0400X9763TXY Chiropractic ProvidersChiropractorRehabilitation

No ID Information.


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