Provider Demographics
NPI:1568169563
Name:PEAK PERFORMANCE WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-916-3377
Mailing Address - Street 1:5225 MORNING SUN RD STE C
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-8929
Mailing Address - Country:US
Mailing Address - Phone:513-916-3377
Mailing Address - Fax:
Practice Address - Street 1:5225 MORNING SUN RD STE C
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-8929
Practice Address - Country:US
Practice Address - Phone:513-916-3377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty