Provider Demographics
NPI:1881037364
Name:PERFORMANCE SPORT & SPINR
Entity Type:Organization
Organization Name:PERFORMANCE SPORT & SPINR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREENWADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-429-4178
Mailing Address - Street 1:6135 284TH WAY NE
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-9517
Mailing Address - Country:US
Mailing Address - Phone:425-429-4178
Mailing Address - Fax:
Practice Address - Street 1:6135 284TH WAY NE
Practice Address - Street 2:
Practice Address - City:CARNATION
Practice Address - State:WA
Practice Address - Zip Code:98014-9517
Practice Address - Country:US
Practice Address - Phone:425-429-4178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60331091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty