Provider Demographics
NPI:1457811366
Name:TRU ATHLETIC PERFORMANCE PLLC
Entity Type:Organization
Organization Name:TRU ATHLETIC PERFORMANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-684-3115
Mailing Address - Street 1:2240 TAYLORSVILLE RD #5295
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40255-4011
Mailing Address - Country:US
Mailing Address - Phone:502-684-3115
Mailing Address - Fax:
Practice Address - Street 1:2240 TAYLORSVILLE RD #5295
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40255-4011
Practice Address - Country:US
Practice Address - Phone:502-684-3115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty