MEDICARE: PERFORMANCE PLUS CHIROPRACTIC 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	5344	AZ

General Provider Information

NPI Number	:	1821302985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE PLUS CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	4410 W UNION HILLS DR STE 7
Second Line	:	309
City	:	GLENDALE
State	:	AZ
Zip	:	85308-1656
Country	:	US
Telephone Number	:	602-765-9736
Fax Number	:	602-942-2106

Provider Business Practice Location Address
First Line	:	5930 W GREENWAY RD STE 26
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-3291
Country	:	US
Telephone Number	:	602-765-9736
Fax Number	:	602-942-2106

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAVID CARL JOHNAON
Credential	:	DC
Telephone Number	:	623-584-9661

Provider Enumeration Date	:	08/01/2010
Last Update Date	:	08/01/2010

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