Provider Demographics
NPI:1023242922
Name:PERFORMANCE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:PERFORMANCE CHIROPRACTIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SINGLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ELLERBROEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-750-1624
Mailing Address - Street 1:801 S ROOSEVELT AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-1691
Mailing Address - Country:US
Mailing Address - Phone:319-754-1400
Mailing Address - Fax:319-754-1401
Practice Address - Street 1:801 S ROOSEVELT AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-1691
Practice Address - Country:US
Practice Address - Phone:319-754-1400
Practice Address - Fax:319-754-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty