Provider Demographics
NPI:1356880272
Name:PEAK PERFORMANCE CHIROPRACTIC
Entity type:Organization
Organization Name:PEAK PERFORMANCE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-449-2915
Mailing Address - Street 1:514 W CLARK ST
Mailing Address - Street 2:340
Mailing Address - City:JASPER
Mailing Address - State:AR
Mailing Address - Zip Code:72641-9723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:514 W CLARK ST
Practice Address - Street 2:340
Practice Address - City:JASPER
Practice Address - State:AR
Practice Address - Zip Code:72641-9723
Practice Address - Country:US
Practice Address - Phone:870-446-6426
Practice Address - Fax:870-446-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty