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General NPI Number Information
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NPI Number | 1336956655
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Entity Type | Organization
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Legal Business Name | PEAK PROFORMANCE CHIROPRACTIC AND REHABILITATION
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 412 W MAIN ST STE 2
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-2912
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Country | US
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Telephone | 302-729-3502
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Fax |
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Provider Business Mailing Address
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Address Line | 920 ACKER PKWY
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City | DEFOREST
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State | WI
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Zip | 53532-3000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATE DREES
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Credential | DC
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Telephone | 312-934-8542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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