MEDICARE: PEAK PERFORMANCE CHIROPRACTIC & HEALTH CENTER, 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	0104747	KS

General Provider Information

NPI Number	:	1245263565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK PERFORMANCE CHIROPRACTIC & HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	3120 MESA WAY
Second Line	:	SUITE A
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4200
Country	:	US
Telephone Number	:	785-842-7325
Fax Number	:	785-842-7329

Provider Business Practice Location Address
First Line	:	3120 MESA WAY
Second Line	:	SUITE A
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4200
Country	:	US
Telephone Number	:	785-842-7325
Fax Number	:	785-842-7329

Authorized Official
Title or Position	:	OWNER
Name	:	ROB D JONES
Credential	:	D.C.
Telephone Number	:	785-842-7325

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	11/02/2010

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