Provider Demographics
NPI:1194191817
Name:PEAK PERFORMANCE CHIROPRACTIC AND SPORTS REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE CHIROPRACTIC AND SPORTS REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:MECHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-406-1414
Mailing Address - Street 1:230 S 400 W
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:UT
Mailing Address - Zip Code:84624-9233
Mailing Address - Country:US
Mailing Address - Phone:435-864-2000
Mailing Address - Fax:435-864-2002
Practice Address - Street 1:60 S 300 E
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-5551
Practice Address - Country:US
Practice Address - Phone:435-864-2000
Practice Address - Fax:435-864-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT94077161202111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty