=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295044931
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERFORMANCE HEALTH& WELLNESS CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2010
-----------------------------------------------------
Last Update Date | 09/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5707 S DIXIE HWY STE D
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33405-3693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-370-3723
-----------------------------------------------------
Fax | 561-370-3953
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5707 S DIXIE HWY STE D
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33405-3693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-370-3723
-----------------------------------------------------
Fax | 561-370-3953
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WILLIAM A HALL
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 561-370-3723
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------