Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 30893 | CA |
NPI | 1235305194 |
---|---|
Provider Name | Dr. Clifton Sergio Perry |
First Address | Pacific Grove, CA 93950-3347 |
Second Address | Pacific Grove, CA 93950-3347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2008 |
Last Update Date | 01/05/2008 |