=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669760526
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERFORMANCE HEALTH & REHABILITATION CHIROPRACTIC CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2011
-----------------------------------------------------
Last Update Date | 10/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3699 ALEXANDRIA PIKE SUITE C
-----------------------------------------------------
City | COLD SPRING
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41076-1789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-360-0664
-----------------------------------------------------
Fax | 859-360-3143
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3699 ALEXANDRIA PIKE SUITE C
-----------------------------------------------------
City | COLD SPRING
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41076-1789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-360-0664
-----------------------------------------------------
Fax | 859-360-3143
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. STEVEN HANNEGAN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 859-360-0664
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 5277
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------