Provider Demographics
NPI:1639737604
Name:CHIROPRACTIC SPORTS PERFORMANCE INSTITUTE
Entity Type:Organization
Organization Name:CHIROPRACTIC SPORTS PERFORMANCE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICCHAEL
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PEPIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP, CSCS
Authorized Official - Phone:401-617-1001
Mailing Address - Street 1:51 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02763-1100
Mailing Address - Country:US
Mailing Address - Phone:508-316-8482
Mailing Address - Fax:508-804-7158
Practice Address - Street 1:51 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO FALLS
Practice Address - State:MA
Practice Address - Zip Code:02763-1100
Practice Address - Country:US
Practice Address - Phone:508-316-8482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty