Healthcare Provider Details

I. General information

NPI: 1225286933
Provider Name (Legal Business Name): PEAK PERFORMANCE CHIROPRACTIC CLINIC INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 BUCKLIN HILL ROAD SUITE #105
SILVERDALE WA
98383
US

IV. Provider business mailing address

PO BOX 5842
BREMERTON WA
98312-0600
US

V. Phone/Fax

Practice location:
  • Phone: 360-830-6596
  • Fax:
Mailing address:
  • Phone: 360-830-6596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60018199
License Number StateWA

VIII. Authorized Official

Name: DR. ROBERT BENJAMIN POCUIS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 360-550-2627