Provider Demographics
NPI:1205238334
Name:MAXIMUM PERFORMANCE CHIROPRACTIC PC
Entity type:Organization
Organization Name:MAXIMUM PERFORMANCE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:WICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-651-6527
Mailing Address - Street 1:208 W CHICAGO RD
Mailing Address - Street 2:SUITE 9B
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1779
Mailing Address - Country:US
Mailing Address - Phone:269-651-6527
Mailing Address - Fax:
Practice Address - Street 1:208 W CHICAGO RD
Practice Address - Street 2:SUITE 9B
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1779
Practice Address - Country:US
Practice Address - Phone:269-651-6527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty