Provider Demographics
NPI:1518599190
Name:PERFORMANCE CHIROPRACTIC OF ORMOND BEACH, LLC
Entity Type:Organization
Organization Name:PERFORMANCE CHIROPRACTIC OF ORMOND BEACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-221-7707
Mailing Address - Street 1:141 BUCKSKIN LN
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8005
Mailing Address - Country:US
Mailing Address - Phone:732-221-7707
Mailing Address - Fax:
Practice Address - Street 1:50 S YONGE ST STE 4
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6289
Practice Address - Country:US
Practice Address - Phone:732-221-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty