Provider Demographics
NPI:1154561124
Name:JET PERFORMANCE CHIROPRACTIC, PA
Entity type:Organization
Organization Name:JET PERFORMANCE CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:ERRON
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-766-9266
Mailing Address - Street 1:12402 W 62ND TER
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1810
Mailing Address - Country:US
Mailing Address - Phone:913-766-9266
Mailing Address - Fax:913-766-9265
Practice Address - Street 1:12402 W 62ND TER
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1810
Practice Address - Country:US
Practice Address - Phone:913-766-9266
Practice Address - Fax:913-766-9265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty