Provider Demographics
NPI:1992468631
Name:VICTORY CHIROPRACTIC AND PERFORMANCE LLC
Entity Type:Organization
Organization Name:VICTORY CHIROPRACTIC AND PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANYIAM
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:484-641-7171
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-0011
Mailing Address - Country:US
Mailing Address - Phone:484-641-7171
Mailing Address - Fax:215-770-0830
Practice Address - Street 1:1404 MANOA RD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3208
Practice Address - Country:US
Practice Address - Phone:484-443-3673
Practice Address - Fax:215-770-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty