Healthcare Provider Details

I. General information

NPI: 1366699407
Provider Name (Legal Business Name): PERFORMANCE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 S ROGERS RD STE A
OLATHE KS
66062-1739
US

IV. Provider business mailing address

708 S ROGERS RD STE A
OLATHE KS
66062-1739
US

V. Phone/Fax

Practice location:
  • Phone: 913-782-5000
  • Fax: 913-782-5005
Mailing address:
  • Phone: 913-782-5000
  • Fax: 913-782-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number01-04631
License Number StateKS

VIII. Authorized Official

Name: DR. BRETT MARTIN DWORKIS
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 913-782-5000