Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 0104000477 | VA |
NPI | 1013026137 |
---|---|
Provider Name | Dr. Theodore Edward Perih |
First Address | Falls Church, VA 22046-3108 |
Second Address | Falls Church, VA 22046-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 30/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017403 | BCBS (01) | |
T73501 | (02) |