Provider Demographics
NPI:1346581899
Name:PEAK PERFORMANCE CHIROPRACTIC AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE CHIROPRACTIC AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-881-8534
Mailing Address - Street 1:5464 PEACHTREE IND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2235
Mailing Address - Country:US
Mailing Address - Phone:770-881-8534
Mailing Address - Fax:770-881-8477
Practice Address - Street 1:5464 PEACHTREE IND BLVD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2235
Practice Address - Country:US
Practice Address - Phone:770-881-8534
Practice Address - Fax:770-881-8477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA07838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJPQMedicare UPIN