Provider Demographics
NPI:1497997027
Name:PEAK PERFORMANCE REHABILITATION AND WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE REHABILITATION AND WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-503-3835
Mailing Address - Street 1:3266 CHIMNEY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-3356
Mailing Address - Country:US
Mailing Address - Phone:325-692-7400
Mailing Address - Fax:325-692-7402
Practice Address - Street 1:3266 CHIMNEY ROCK RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3356
Practice Address - Country:US
Practice Address - Phone:325-692-7400
Practice Address - Fax:325-692-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10825111N00000X
TX11139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty