Provider Demographics
NPI:1689933269
Name:IDEAL PERFORMANCE INCORPORATED
Entity Type:Organization
Organization Name:IDEAL PERFORMANCE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-312-9554
Mailing Address - Street 1:1544 UPPER KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-6859
Mailing Address - Country:US
Mailing Address - Phone:334-322-9862
Mailing Address - Fax:
Practice Address - Street 1:1544 UPPER KINGSTON RD
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-6859
Practice Address - Country:US
Practice Address - Phone:334-322-9862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty