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General NPI Number Information
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NPI Number | 1881116325
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Entity Type | Organization
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Legal Business Name | PERFORMANCE CHIROPRACTIC CLINIC INC
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Dates
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Enumeration Date | 07/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 15859 E JAMISON DR APT 19110
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City | ENGLEWOOD
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State | CO
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Zip | 80112-4681
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Country | US
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Telephone | 406-498-1691
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Fax |
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Provider Business Mailing Address
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Address Line | 15859 E JAMISON DR APT 19110
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City | ENGLEWOOD
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State | CO
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Zip | 80112-4681
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Country | US
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Telephone | 406-498-1691
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | BRETT STEVEN BOND
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Credential | DC
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Telephone | 406-498-1691
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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 | CHR.0007589
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License Number State | CO
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