Provider Demographics
NPI:1780286476
Name:PERFORMANCE SPINE AND SPORT HOLDINGS LLC
Entity type:Organization
Organization Name:PERFORMANCE SPINE AND SPORT HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:RINN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-208-7810
Mailing Address - Street 1:1871 S RANDALL RD STE E
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4434
Mailing Address - Country:US
Mailing Address - Phone:630-208-7810
Mailing Address - Fax:
Practice Address - Street 1:1871 S RANDALL RD STE E
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4434
Practice Address - Country:US
Practice Address - Phone:630-208-7810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty