Provider Demographics
NPI:1710295910
Name:PERFORMANCE HEALTH CHIROPRACTIC PLC
Entity Type:Organization
Organization Name:PERFORMANCE HEALTH CHIROPRACTIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-929-4523
Mailing Address - Street 1:2330 E STADIUM BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4820
Mailing Address - Country:US
Mailing Address - Phone:734-929-4523
Mailing Address - Fax:
Practice Address - Street 1:2330 E STADIUM BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4820
Practice Address - Country:US
Practice Address - Phone:734-929-4523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty