Provider Demographics
NPI:1134366743
Name:PROACTIVE PERFORMANCE CENTERS, LLC
Entity type:Organization
Organization Name:PROACTIVE PERFORMANCE CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:FERRO
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:516-351-9739
Mailing Address - Street 1:1591 1 STREET
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704
Mailing Address - Country:US
Mailing Address - Phone:631-251-6439
Mailing Address - Fax:631-539-2573
Practice Address - Street 1:7101 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612
Practice Address - Country:US
Practice Address - Phone:516-351-9739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC FITNESS CENTERS,PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty