Provider Demographics
NPI:1700278983
Name:PERFORMANCE SPINE & SPORT LLC
Entity Type:Organization
Organization Name:PERFORMANCE SPINE & SPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:TUCHSCHERER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-801-7999
Mailing Address - Street 1:2597 S. BROADWAY SUITE A
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762
Mailing Address - Country:US
Mailing Address - Phone:620-308-6576
Mailing Address - Fax:
Practice Address - Street 1:2597 S. BROADWAY SUITE A
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762
Practice Address - Country:US
Practice Address - Phone:620-308-6576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty