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General NPI Number Information
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NPI Number | 1881745362
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Entity Type | Organization
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Legal Business Name | PEAK PERFORMANCE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 01/13/2007
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 319 BROADWAY
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City | MENANDS
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State | NY
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Zip | 12204
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Country | US
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Telephone | 518-472-9130
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Fax | 518-472-9351
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Provider Business Mailing Address
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Address Line | 319 BROADWAY
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City | MENANDS
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State | NY
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Zip | 12204
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Country | US
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Telephone | 518-472-9130
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Fax | 518-472-9351
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | MR. ERIC LUPER
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Credential | DC
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Telephone | 518-472-9130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | X0094561
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License Number State | NY
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