Provider Demographics
NPI:1144429283
Name:CHIROPRACTIC PERFORMANCE CENTER, PA
Entity Type:Organization
Organization Name:CHIROPRACTIC PERFORMANCE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CUPERUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-255-0961
Mailing Address - Street 1:2380 TROOP DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4637
Mailing Address - Country:US
Mailing Address - Phone:320-255-0961
Mailing Address - Fax:320-258-4001
Practice Address - Street 1:2380 TROOP DRIVE
Practice Address - Street 2:SUTIE 201
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4637
Practice Address - Country:US
Practice Address - Phone:320-255-0961
Practice Address - Fax:320-258-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN786261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002734OtherMEDICARE INDIVIDUAL #
MN332J9KLOtherBCBS INDIVIDUAL #
MN331J2CHOtherBCBS - CLINIC #
MN777641100Medicaid
MN965001033012OtherPREFERRED ONE
MNC03940OtherMEIDCARE CLINIC #
MN777641100Medicaid