| NPI | 1710239264 |
|---|---|
| Doing Business As | PERFORMANCE CHIROPRACTIC AND SPORTS REHAB |
| Entity Type | Organization |
| Authorized Contact | DEREK ALAN LEIST President 314-954-1885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL IL038012269) |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2012-10-09 |