Provider Demographics
NPI:1710307244
Name:PEAK PERFORMANCE CHIROPRACTIC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WENSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-561-1770
Mailing Address - Street 1:5705 LEE BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-6342
Mailing Address - Country:US
Mailing Address - Phone:239-561-1770
Mailing Address - Fax:
Practice Address - Street 1:5705 LEE BLVD
Practice Address - Street 2:STE 9
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-6342
Practice Address - Country:US
Practice Address - Phone:239-246-2772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9108111N00000X
FLCH9327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty