=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114502143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERFORMANCE CHIROPRACTIC AND REHABILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2021
-----------------------------------------------------
Last Update Date | 03/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 N MOUNTAIN RD
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17112-2373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-695-3540
-----------------------------------------------------
Fax | 717-307-3514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 N MOUNTAIN RD
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17112-2373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-695-3540
-----------------------------------------------------
Fax | 717-307-3514
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MELANIE NORRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-695-3540
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------