Provider Demographics
NPI:1730571027
Name:PERFORMANCE HEALTH PC
Entity type:Organization
Organization Name:PERFORMANCE HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-226-3724
Mailing Address - Street 1:37450 GARFIELD RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3657
Mailing Address - Country:US
Mailing Address - Phone:586-226-3724
Mailing Address - Fax:586-226-9605
Practice Address - Street 1:37450 GARFIELD RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-3657
Practice Address - Country:US
Practice Address - Phone:586-226-3724
Practice Address - Fax:586-226-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty