Doctor Name: | TRACY B PERUCH |
NPI Number: | 1124026307 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | 5710 |
Business Practice Address: | 6770 W Deer Valley Rd #b102 Glendale, AZ - 853105956 |
Business Phone Number: | 6233621950 |
Business Fax Number: | 6235722741 |
Mailing Address: | 6770 W Deer Valley Rd, #b102 GLENDALE |
State: | AZ |
Postal Code: | 853105956 |
Phone Number: | 6233621950 |
Fax Number: | 6235722741 |
NPI Enumeration Date: | 07/12/2005 |
NPI Last Update Date: | 04/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 5710 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |