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General NPI Number Information
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NPI Number | 1568588689
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Entity Type | Organization
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Legal Business Name | PERFORMANCE HEALTHCARE
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 10130 DAVENPORT ST NE SUITE 180
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City | BLAINE
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State | MN
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Zip | 55449-4776
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Country | US
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Telephone | 763-784-3004
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Fax | 763-780-3004
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Provider Business Mailing Address
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Address Line | PO BOX 490005
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City | BLAINE
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State | MN
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Zip | 55449-0005
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Country | US
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Telephone | 763-784-3004
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Fax | 763-780-3004
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. SCOTT THOMAS OSWALD
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Credential | D.C.
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Telephone | 763-784-3004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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