MEDICARE: PERFORMANCE AND RECOVERY CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1205566163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE AND RECOVERY CLINIC LLC

Provider Business Mailing Address
First Line	:	1117 VILLAGE RD
Second Line	:
City	:	CARBONDALE
State	:	CO
Zip	:	81623-2522
Country	:	US
Telephone Number	:	970-279-1847
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 VILLAGE RD
Second Line	:
City	:	CARBONDALE
State	:	CO
Zip	:	81623-2522
Country	:	US
Telephone Number	:	970-279-1847
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH M FERET
Credential	:	DC
Telephone Number	:	970-279-1847

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	06/29/2022

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