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General NPI Number Information
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NPI Number | 1215244058
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Entity Type | Organization
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Legal Business Name | PERFORMANCE WELLNESS INC
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 9150 W INDIAN SCHOOL RD SUITE 139
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City | PHOENIX
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State | AZ
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Zip | 85037-2384
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Country | US
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Telephone | 623-826-4846
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Fax |
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Provider Business Mailing Address
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Address Line | 9150 W INDIAN SCHOOL RD SUITE 139
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City | PHOENIX
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State | AZ
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Zip | 85037-2384
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Country | US
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Telephone | 623-826-4846
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN G HOFMEIR
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Credential | DC
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Telephone | 623-826-4846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 7391
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License Number State | AZ
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