Healthcare Provider Details

I. General information

NPI: 1205277506
Provider Name (Legal Business Name): PEAK PERFORMANCE CHIROPRACTIC & SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 MONUMENT RD SUITE 16
JACKSONVILLE FL
32225-3531
US

IV. Provider business mailing address

2485 MONUMENT RD SUITE 16
JACKSONVILLE FL
32225-3531
US

V. Phone/Fax

Practice location:
  • Phone: 904-351-6596
  • Fax:
Mailing address:
  • Phone: 904-351-6596
  • Fax: 904-212-0484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH10484
License Number StateFL

VIII. Authorized Official

Name: DR. JOY M HENRY
Title or Position: CHIROPRACTOR/ OWNER
Credential: DC
Phone: 904-351-6596