Provider Demographics
NPI:1790165215
Name:PERFORMANCE CHIROPRACTIC & SPORTS MEDICINE
Entity Type:Organization
Organization Name:PERFORMANCE CHIROPRACTIC & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:TEAL
Authorized Official - Last Name:DARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-473-8980
Mailing Address - Street 1:6001 WINDHAVEN PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8017
Mailing Address - Country:US
Mailing Address - Phone:972-473-8980
Mailing Address - Fax:972-212-6851
Practice Address - Street 1:6001 WINDHAVEN PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8017
Practice Address - Country:US
Practice Address - Phone:972-473-8980
Practice Address - Fax:972-212-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0010135111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty