MEDICARE: PERFORMANCE HEALTH& WELLNESS CENTER INC

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	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1295044931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE HEALTH& WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	5707 S DIXIE HWY STE D
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-3693
Country	:	US
Telephone Number	:	561-370-3723
Fax Number	:	561-370-3953

Provider Business Practice Location Address
First Line	:	5707 S DIXIE HWY STE D
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-3693
Country	:	US
Telephone Number	:	561-370-3723
Fax Number	:	561-370-3953

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM A HALL
Credential	:	DC
Telephone Number	:	561-370-3723

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	09/29/2010

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