Provider Demographics
NPI:1063859601
Name:COMPLETE PERFORMANCE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:COMPLETE PERFORMANCE CHIROPRACTIC LLC
Other - Org Name:COMPLETE PERFORMANCE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LEITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-485-9972
Mailing Address - Street 1:4127 MEXICO RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6410
Mailing Address - Country:US
Mailing Address - Phone:636-485-9972
Mailing Address - Fax:
Practice Address - Street 1:4127 MEXICO RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6410
Practice Address - Country:US
Practice Address - Phone:636-485-9972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130113332111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty