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General NPI Number Information
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NPI Number | 1700278983
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Entity Type | Organization
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Legal Business Name | PERFORMANCE SPINE & SPORT LLC
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 2597 S. BROADWAY SUITE A
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City | PITTSBURG
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State | KS
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Zip | 66762
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Country | US
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Telephone | 620-308-6576
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Fax |
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Provider Business Mailing Address
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Address Line | 2597 S. BROADWAY SUITE A
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City | PITTSBURG
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State | KS
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Zip | 66762
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Country | US
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Telephone | 620-308-6576
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN AUSTIN TUCHSCHERER
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Credential | D.C.
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Telephone | 303-801-7999
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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 |
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License Number State |
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