Healthcare Provider Details

I. General information

NPI: 1891281101
Provider Name (Legal Business Name): PERFORMANCE CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7343 ATLAS WALK WAY
GAINESVILLE VA
20155-2992
US

IV. Provider business mailing address

5551 TOURNAMENT DR
HAYMARKET VA
20169-3101
US

V. Phone/Fax

Practice location:
  • Phone: 703-477-6174
  • Fax:
Mailing address:
  • Phone: 703-477-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001526
License Number StateVA

VIII. Authorized Official

Name: DR. KRISTINE MAGGS
Title or Position: OWNER
Credential: DC
Phone: 703-477-6174