Provider Demographics
NPI:1740857846
Name:PERFORMANCE HEALTH CLINICS OF SHREWSBURY LLC
Entity type:Organization
Organization Name:PERFORMANCE HEALTH CLINICS OF SHREWSBURY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:SMOLAREK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-601-6783
Mailing Address - Street 1:46 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1864
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 BOSTON TPKE STE 201
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3414
Practice Address - Country:US
Practice Address - Phone:201-962-9066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty