Provider Demographics
NPI:1861182800
Name:LUCIANO PEREZ, LUIS OMAR (DC)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:OMAR
Last Name:LUCIANO PEREZ
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 1:105 SIGMON DR
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-1872
Mailing Address - Country:US
Mailing Address - Phone:787-462-9505
Mailing Address - Fax:
Practice Address - Street 1:851 JOHN B WHITE SR BLVD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-4037
Practice Address - Country:US
Practice Address - Phone:864-707-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor