Provider Demographics
NPI:1417403577
Name:PERFORMANCE SPINE & SPORT REHABILITATION INC
Entity Type:Organization
Organization Name:PERFORMANCE SPINE & SPORT REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MAC
Authorized Official - Last Name:SWARINGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-400-1528
Mailing Address - Street 1:10945 N MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6501
Mailing Address - Country:US
Mailing Address - Phone:561-400-1528
Mailing Address - Fax:561-412-1277
Practice Address - Street 1:10945 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6501
Practice Address - Country:US
Practice Address - Phone:561-400-1528
Practice Address - Fax:561-412-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty