Provider Demographics
NPI:1710756176
Name:ADVANCED PERFORMANCE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ADVANCED PERFORMANCE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:573-816-3030
Mailing Address - Street 1:1438 BRAMBLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-1165
Mailing Address - Country:US
Mailing Address - Phone:573-703-4637
Mailing Address - Fax:573-816-3031
Practice Address - Street 1:145 S MOUNT AUBURN RD STE A
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4913
Practice Address - Country:US
Practice Address - Phone:573-816-3030
Practice Address - Fax:573-816-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty