Provider Demographics
NPI:1154779452
Name:PEAK PERFORMANCE CHIROPRACTIC AND ANTI-AGING, INC.
Entity type:Organization
Organization Name:PEAK PERFORMANCE CHIROPRACTIC AND ANTI-AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-427-3255
Mailing Address - Street 1:6010 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3355
Mailing Address - Country:US
Mailing Address - Phone:614-427-3255
Mailing Address - Fax:614-304-6181
Practice Address - Street 1:6935 KINDLER DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9062
Practice Address - Country:US
Practice Address - Phone:614-427-3255
Practice Address - Fax:614-304-6181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty