Provider Demographics
NPI:1316202039
Name:PEAK PERFORMANCE CHIROPRACTIC, NUTRITION, & REHABILITATION CLINIC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE CHIROPRACTIC, NUTRITION, & REHABILITATION CLINIC
Other - Org Name:PEAK PERFORMANCE CNR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-599-8828
Mailing Address - Street 1:3046 COLUMBIA AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-7429
Mailing Address - Country:US
Mailing Address - Phone:615-599-8828
Mailing Address - Fax:
Practice Address - Street 1:3046 COLUMBIA AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-7429
Practice Address - Country:US
Practice Address - Phone:615-599-8828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2561111N00000X, 111NI0900X, 111NN1001X, 111NR0400X
TN2562111N00000X, 111NI0900X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty