=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730447533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEAK PERFORMANCE CHIROPRACTIC CENTERS, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2012
-----------------------------------------------------
Last Update Date | 04/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 212 FRASER DR
-----------------------------------------------------
City | HINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31313-3711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-408-2121
-----------------------------------------------------
Fax | 912-320-4587
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1027 BARLEY DR
-----------------------------------------------------
City | HINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31313-9469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-288-0678
-----------------------------------------------------
Fax | 912-320-4587
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. MONICA MERRITT GILBERT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 229-288-0678
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR008623
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------