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General NPI Number Information
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NPI Number | 1821302985
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Entity Type | Organization
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Legal Business Name | PERFORMANCE PLUS CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/01/2010
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Last Update Date | 08/01/2010
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Provider Practice Location Address
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Address Line | 5930 W GREENWAY RD STE 26
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City | GLENDALE
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State | AZ
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Zip | 85306-3291
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Country | US
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Telephone | 602-765-9736
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Fax | 602-942-2106
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Provider Business Mailing Address
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Address Line | 4410 W UNION HILLS DR STE 7 309
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City | GLENDALE
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State | AZ
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Zip | 85308-1656
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Country | US
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Telephone | 602-765-9736
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Fax | 602-942-2106
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID CARL JOHNAON
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Credential | DC
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Telephone | 623-584-9661
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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 | 5344
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License Number State | AZ
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