Healthcare Provider Details

I. General information

NPI: 1356880272
Provider Name (Legal Business Name): PEAK PERFORMANCE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 W CLARK ST 340
JASPER AR
72641-9723
US

IV. Provider business mailing address

514 W CLARK ST 340
JASPER AR
72641-9723
US

V. Phone/Fax

Practice location:
  • Phone: 870-446-6426
  • Fax: 870-446-2799
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16144
License Number StateAR

VIII. Authorized Official

Name: DR. TEMBER MCNEILL
Title or Position: OWNER
Credential: D.C.
Phone: 314-449-2915