Provider Demographics
NPI:1528144326
Name:PERRY, SETH M (DC)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:M
Last Name:PERRY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EAST CANAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2111
Mailing Address - Country:US
Mailing Address - Phone:815-434-0803
Mailing Address - Fax:815-434-0772
Practice Address - Street 1:111 EAST CANAL AVENUE
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2111
Practice Address - Country:US
Practice Address - Phone:815-434-0803
Practice Address - Fax:815-434-0772
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009546Medicaid
K26526Medicare ID - Type Unspecified