=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770050486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERFORMANCE IN MOTION CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2018
-----------------------------------------------------
Last Update Date | 07/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 WILLOW AVE STE 511
-----------------------------------------------------
City | COUNCIL BLUFFS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51503-0827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-322-8241
-----------------------------------------------------
Fax | 712-322-8250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 WILLOW AVE STE 511
-----------------------------------------------------
City | COUNCIL BLUFFS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51503-0827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-322-8241
-----------------------------------------------------
Fax | 712-322-8250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTIC PHYSICIAN
-----------------------------------------------------
Name | DR. JOSHUA DAVID OWEN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 712-322-8241
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------