Provider Demographics
NPI:1871989921
Name:PERFORMANCE HEALTH & INTEGRATED SPINE CARE, LLC
Entity type:Organization
Organization Name:PERFORMANCE HEALTH & INTEGRATED SPINE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:INGUI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-962-9066
Mailing Address - Street 1:46 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1808
Mailing Address - Country:US
Mailing Address - Phone:201-962-9066
Mailing Address - Fax:201-962-9068
Practice Address - Street 1:46 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1808
Practice Address - Country:US
Practice Address - Phone:201-962-9066
Practice Address - Fax:201-962-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00722900111N00000X
111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty