Provider Demographics
NPI:1760196406
Name:DENNER CHIROPRACTIC AND PERFORMANCE PLLC
Entity Type:Organization
Organization Name:DENNER CHIROPRACTIC AND PERFORMANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-680-5866
Mailing Address - Street 1:13501 DORMAN RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-9334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13501 DORMAN RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-9334
Practice Address - Country:US
Practice Address - Phone:704-325-9767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty