Provider Demographics
NPI:1336208552
Name:MICHAEL S. KIRK, JR.
Entity Type:Organization
Organization Name:MICHAEL S. KIRK, JR.
Other - Org Name:PERFORMANCE HEALTH & CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:856-727-8300
Mailing Address - Street 1:300 CHESTER AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2512
Mailing Address - Country:US
Mailing Address - Phone:856-727-8300
Mailing Address - Fax:856-727-8346
Practice Address - Street 1:300 CHESTER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2512
Practice Address - Country:US
Practice Address - Phone:856-727-8300
Practice Address - Fax:856-727-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00578200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3557463OtherAETNA
NJ7272582OtherAETNA
NJ2410673000OtherAMERIHEALTH IBC
NJ001745107OtherPERSONAL CHOICE
NJV00387Medicare UPIN
NJ077606Medicare ID - Type Unspecified