Provider Demographics
NPI:1356989131
Name:MOBILE CHIRO AND PERFORMANCE, LLC
Entity type:Organization
Organization Name:MOBILE CHIRO AND PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KORY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-259-8365
Mailing Address - Street 1:604 EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6649
Mailing Address - Country:US
Mailing Address - Phone:386-259-8365
Mailing Address - Fax:
Practice Address - Street 1:604 EDWARD ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6649
Practice Address - Country:US
Practice Address - Phone:386-259-8365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty