Provider Demographics
NPI:1508378340
Name:SHENANDOAH VALLEY PERFORMANCE CLINIC
Entity Type:Organization
Organization Name:SHENANDOAH VALLEY PERFORMANCE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-217-0429
Mailing Address - Street 1:3211 PEOPLES DR STE 140
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-7621
Mailing Address - Country:US
Mailing Address - Phone:540-217-0429
Mailing Address - Fax:
Practice Address - Street 1:3211 PEOPLES DR STE 140
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-7621
Practice Address - Country:US
Practice Address - Phone:540-217-0429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557304111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104-557304OtherLICENSE
1992161731OtherNPI