Provider Demographics
NPI:1568588689
Name:PERFORMANCE HEALTHCARE
Entity Type:Organization
Organization Name:PERFORMANCE HEALTHCARE
Other - Org Name:THE CENTER FOR CHIROPRACTIC & HUMAN PERFORMANCE, LLP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-784-3004
Mailing Address - Street 1:PO BOX 490005
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-0005
Mailing Address - Country:US
Mailing Address - Phone:763-784-3004
Mailing Address - Fax:763-780-3004
Practice Address - Street 1:10130 DAVENPORT ST NE
Practice Address - Street 2:SUITE 180
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4776
Practice Address - Country:US
Practice Address - Phone:763-784-3004
Practice Address - Fax:763-780-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty