Provider Demographics
NPI:1467088542
Name:PEAK PERFORMANCE CHIROPRACTIC AND REHAB LLC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE CHIROPRACTIC AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GEORGESON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-963-4985
Mailing Address - Street 1:412 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2912
Mailing Address - Country:US
Mailing Address - Phone:608-318-2713
Mailing Address - Fax:
Practice Address - Street 1:132 ALTON DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-9156
Practice Address - Country:US
Practice Address - Phone:608-963-4985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center