Provider Demographics
NPI:1205100096
Name:PERFORMANCE HEALTH SPINE & SPORT THERAPY
Entity type:Organization
Organization Name:PERFORMANCE HEALTH SPINE & SPORT THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:COAPLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CSCS, ART
Authorized Official - Phone:603-724-2297
Mailing Address - Street 1:91A N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4334
Mailing Address - Country:US
Mailing Address - Phone:603-724-2297
Mailing Address - Fax:603-369-3017
Practice Address - Street 1:91A N STATE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4334
Practice Address - Country:US
Practice Address - Phone:603-724-2297
Practice Address - Fax:603-369-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH965111N00000X
NH3813225100000X
MA20597225100000X
NH7850407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty