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General NPI Number Information
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NPI Number | 1891281101
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Entity Type | Organization
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Legal Business Name | PERFORMANCE CARE CORPORATION
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 7343 ATLAS WALK WAY
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City | GAINESVILLE
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State | VA
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Zip | 20155-2992
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Country | US
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Telephone | 703-477-6174
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Fax |
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Provider Business Mailing Address
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Address Line | 5551 TOURNAMENT DR
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City | HAYMARKET
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State | VA
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Zip | 20169-3101
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Country | US
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Telephone | 703-477-6174
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISTINE MAGGS
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Credential | DC
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Telephone | 703-477-6174
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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 | 0104001526
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License Number State | VA
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