Provider Demographics
NPI:1346613155
Name:PEAK PERFORMANCE CHIROPRACTIC AND WELLNESS, P.C.
Entity Type:Organization
Organization Name:PEAK PERFORMANCE CHIROPRACTIC AND WELLNESS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-526-7479
Mailing Address - Street 1:3603 BRAMBLETON AVE
Mailing Address - Street 2:STE A
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3600
Mailing Address - Country:US
Mailing Address - Phone:540-526-7479
Mailing Address - Fax:540-685-4415
Practice Address - Street 1:3603 BRAMBLETON AVE
Practice Address - Street 2:STE A
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3600
Practice Address - Country:US
Practice Address - Phone:540-526-7479
Practice Address - Fax:540-685-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557037111N00000X
VA2305208412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty