Provider Demographics
NPI:1871548859
Name:PERFORMANCE CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:PERFORMANCE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BLETZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-761-9702
Mailing Address - Street 1:1605 W WILSON ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1627
Mailing Address - Country:US
Mailing Address - Phone:630-761-9702
Mailing Address - Fax:630-444-1855
Practice Address - Street 1:1605 W WILSON ST
Practice Address - Street 2:SUITE 114
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1627
Practice Address - Country:US
Practice Address - Phone:630-761-9702
Practice Address - Fax:630-444-1855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010143305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization