Provider Demographics
NPI:1679637227
Name:PERFORMANCE CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:PERFORMANCE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-442-2448
Mailing Address - Street 1:103 RESCIA AVE
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-5930
Mailing Address - Country:US
Mailing Address - Phone:256-442-2448
Mailing Address - Fax:256-442-2498
Practice Address - Street 1:103 RESCIA AVE
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-5930
Practice Address - Country:US
Practice Address - Phone:256-442-2448
Practice Address - Fax:256-442-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051555932STEMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ALV05009Medicare UPIN
AL051555910FROMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ALU19035Medicare UPIN