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General NPI Number Information
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NPI Number | 1396903795
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Entity Type | Organization
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Legal Business Name | PERFORMANCE CHIROPRACTIC
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 131 PEARL ST
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-3626
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Country | US
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Telephone | 802-878-4946
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Fax | 802-878-9625
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Provider Business Mailing Address
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Address Line | 131 PEARL ST
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-3626
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Country | US
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Telephone | 802-878-4946
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Fax | 802-878-9625
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHERINE LEE WIEBE
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Credential | DC
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Telephone | 802-878-4946
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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 | 006-0001098
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 006-0001086
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License Number State | VT
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