Provider Demographics
NPI:1174180103
Name:PEAK PERFORMANCE LTD
Entity Type:Organization
Organization Name:PEAK PERFORMANCE LTD
Other - Org Name:SMITH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMMON
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-380-8463
Mailing Address - Street 1:1825 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1100
Mailing Address - Country:US
Mailing Address - Phone:719-390-5404
Mailing Address - Fax:719-390-8313
Practice Address - Street 1:1825 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1100
Practice Address - Country:US
Practice Address - Phone:719-390-5404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1194034314Medicaid