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General NPI Number Information
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NPI Number | 1730422288
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Entity Type | Organization
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Legal Business Name | PEAK PERFORMANCE CHIROPRACTIC AND SPORTS INJURY CENTER, LLC
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 8630 E VIA DE VENTURA STE 210
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-3326
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Country | US
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Telephone | 480-767-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 8630 E VIA DE VENTURA STE 210
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-3326
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Country | US
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Telephone | 480-767-3300
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | SOPHIE BRODEUR
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Credential | D.C.
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Telephone | 480-767-3300
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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 | 7562
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License Number State | AZ
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