Provider Demographics
NPI:1932422888
Name:PROFORMANCE HEALTH LLC
Entity Type:Organization
Organization Name:PROFORMANCE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:AVELAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-607-9779
Mailing Address - Street 1:14300 N NORTHSIGHT BLVD
Mailing Address - Street 2:STE. 116
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3672
Mailing Address - Country:US
Mailing Address - Phone:480-607-9779
Mailing Address - Fax:480-607-5804
Practice Address - Street 1:14300 N NORTHSIGHT BLVD
Practice Address - Street 2:STE 116
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3672
Practice Address - Country:US
Practice Address - Phone:480-607-9779
Practice Address - Fax:480-607-5804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-07
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty