Basic Information
Provider Information
NPI: 1760452510
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PERRY
FirstName: RAYMOND
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: D.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 624 S SEGUIN AVE
Address2:  
City: NEW BRAUNFELS
State: TX
PostalCode: 781307647
CountryCode: US
TelephoneNumber: 8306299909
FaxNumber: 8306209073
Practice Location
Address1: 624 S SEGUIN AVE
Address2:  
City: NEW BRAUNFELS
State: TX
PostalCode: 781307647
CountryCode: US
TelephoneNumber: 8306299909
FaxNumber: 8306209073
Other Information
ProviderEnumerationDate: 01/25/2006
LastUpdateDate: 07/11/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000X5585TXY Chiropractic ProvidersChiropractor 

No ID Information.


Home