Provider Demographics
NPI:1215752233
Name:PEAK PERFORMANCE SPORT & SPINE LLC
Entity type:Organization
Organization Name:PEAK PERFORMANCE SPORT & SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEDGES
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS, CCSP
Authorized Official - Phone:740-503-8911
Mailing Address - Street 1:2265 W FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8821
Mailing Address - Country:US
Mailing Address - Phone:740-494-1470
Mailing Address - Fax:740-494-1471
Practice Address - Street 1:2265 W FAIR AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8821
Practice Address - Country:US
Practice Address - Phone:740-494-1470
Practice Address - Fax:740-494-1471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty