Provider Demographics
NPI:1235247420
Name:PEAK PERFORMANCE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-552-3671
Mailing Address - Street 1:1999 S MAIN ST
Mailing Address - Street 2:SUITE 305-A
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6634
Mailing Address - Country:US
Mailing Address - Phone:540-552-3671
Mailing Address - Fax:540-552-3741
Practice Address - Street 1:1999 S MAIN ST
Practice Address - Street 2:SUITE 305-A
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6634
Practice Address - Country:US
Practice Address - Phone:540-552-3671
Practice Address - Fax:540-552-3741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU98982Medicare UPIN
VAC09952Medicare PIN