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General NPI Number Information
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NPI Number | 1972801058
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Entity Type | Organization
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Legal Business Name | PEAK PERFORMANCE CHIROPRACTIC REHABILITATION INC.
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Dates
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Enumeration Date | 03/14/2011
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Last Update Date | 03/14/2011
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Provider Practice Location Address
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Address Line | 207 GREEN ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-2660
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Country | US
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Telephone | 617-971-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 207 GREEN ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-2660
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Country | US
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Telephone | 617-971-0001
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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. EDWARD V CHAVEZ
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Credential |
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Telephone | 617-971-0001
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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 | 2577
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License Number State | MA
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