Provider Demographics
NPI:1821302985
Name:PERFORMANCE PLUS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PERFORMANCE PLUS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:JOHNAON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-584-9661
Mailing Address - Street 1:4410 W UNION HILLS DR STE 7
Mailing Address - Street 2:309
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1656
Mailing Address - Country:US
Mailing Address - Phone:602-765-9736
Mailing Address - Fax:602-942-2106
Practice Address - Street 1:5930 W GREENWAY RD STE 26
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3291
Practice Address - Country:US
Practice Address - Phone:602-765-9736
Practice Address - Fax:602-942-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-01
Last Update Date:2010-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty