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General NPI Number Information
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NPI Number | 1154141596
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Entity Type | Organization
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Legal Business Name | PERFORM4LIFE, LLC
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 1927 LINCOLN DR
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City | ANNAPOLIS
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State | MD
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Zip | 21401-4118
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Country | US
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Telephone | 301-787-4565
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Fax |
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Provider Business Mailing Address
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Address Line | 6192 GREENBLADE GARTH
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City | COLUMBIA
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State | MD
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Zip | 21045-4217
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Country | US
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Telephone | 301-787-4565
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. CARTER SCHMIDT
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Credential | DC
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Telephone | 301-787-4565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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