Healthcare Provider Details

I. General information

NPI: 1538440375
Provider Name (Legal Business Name): PEAK PERFORMANCE OF WESTERN COLO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 N 7TH ST
GRAND JUNCTION CO
81501-3053
US

IV. Provider business mailing address

1445 N 7TH ST
GRAND JUNCTION CO
81501-3053
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-1903
  • Fax: 970-256-1113
Mailing address:
  • Phone: 970-242-1903
  • Fax: 970-256-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number4404
License Number StateCO

VIII. Authorized Official

Name: DR. DEAN ANDREW YOUNKER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 970-242-1903