Provider Demographics
NPI:1578685228
Name:PEAK PERFORMANCE CHIROPRACTIC & WELLNESS, L.L.C
Entity Type:Organization
Organization Name:PEAK PERFORMANCE CHIROPRACTIC & WELLNESS, L.L.C
Other - Org Name:CHRONICARE OF UTAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DARREN
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-776-3200
Mailing Address - Street 1:2297 N HILLFIELD RD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041
Mailing Address - Country:US
Mailing Address - Phone:801-444-3033
Mailing Address - Fax:
Practice Address - Street 1:2297 N HILLFIELD RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041
Practice Address - Country:US
Practice Address - Phone:801-444-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4957561-1202111N00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU89733Medicare UPIN