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General NPI Number Information
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NPI Number | 1285353623
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Entity Type | Organization
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Legal Business Name | PRINCIPLE PERFORMANCE, INC
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Dates
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Enumeration Date | 08/26/2022
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 200 HOWARD AVE STE 230
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City | DES PLAINES
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State | IL
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Zip | 60018-5908
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Country | US
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Telephone | 224-725-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 200 HOWARD AVE STE 230
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City | DES PLAINES
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State | IL
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Zip | 60018-5908
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Country | US
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Telephone | 224-725-3151
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. MICHAEL JEREMY GONTAREK
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Credential | DC, MSC, DACBN
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Telephone | 630-709-2868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number |
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License Number State |
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