Provider Demographics
NPI:1831188754
Name:PERKINS, JAMES EDWARD JR (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:PERKINS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:111 S MAIN
Mailing Address - City:HOMEDALE
Mailing Address - State:ID
Mailing Address - Zip Code:83628-0335
Mailing Address - Country:US
Mailing Address - Phone:208-337-4900
Mailing Address - Fax:208-337-3736
Practice Address - Street 1:111 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOMEDALE
Practice Address - State:ID
Practice Address - Zip Code:83628-3421
Practice Address - Country:US
Practice Address - Phone:208-337-4900
Practice Address - Fax:208-337-3736
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T81757Medicare UPIN
16722661Medicare PIN