=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457760936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEAK PERFORMANCE SPINE & SPORTS MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2014
-----------------------------------------------------
Last Update Date | 08/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4802 E SAM HOUSTON PKWY S SUITE 115
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77505-3968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-991-3002
-----------------------------------------------------
Fax | 281-991-3022
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4802 E SAM HOUSTON PKWY S SUITE 115
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77505-3968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-991-3002
-----------------------------------------------------
Fax | 281-991-3022
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. ROBERT ALAN BARTON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 832-347-7430
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 12583
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------