Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5376 | AZ |
NPI | 1003984220 |
---|---|
Provider Name | Dr. Robert Karl Perry |
First Address | Flagstaff, AZ 86004-2817 |
Second Address | Flagstaff, AZ 86004-3719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |