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General NPI Number Information
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NPI Number | 1225286933
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Entity Type | Organization
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Legal Business Name | PEAK PERFORMANCE CHIROPRACTIC CLINIC INC PS
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Dates
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Enumeration Date | 09/05/2008
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 3100 BUCKLIN HILL ROAD SUITE #105
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City | SILVERDALE
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State | WA
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Zip | 98383
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Country | US
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Telephone | 360-830-6596
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5842
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City | BREMERTON
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State | WA
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Zip | 98312-0600
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Country | US
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Telephone | 360-830-6596
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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. ROBERT BENJAMIN POCUIS
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Credential | D.C.
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Telephone | 360-550-2627
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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 | CH60018199
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License Number State | WA
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