Provider Demographics
NPI:1770050486
Name:PERFORMANCE IN MOTION CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:PERFORMANCE IN MOTION CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-322-8241
Mailing Address - Street 1:500 WILLOW AVE STE 511
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0827
Mailing Address - Country:US
Mailing Address - Phone:712-322-8241
Mailing Address - Fax:712-322-8250
Practice Address - Street 1:500 WILLOW AVE STE 511
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0827
Practice Address - Country:US
Practice Address - Phone:712-322-8241
Practice Address - Fax:712-322-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty