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Organization
PERFORMANCE CHIROPRACTIC CENTER, S.C.
Active
Organization
PERFORMANCE CHIROPRACTIC CENTER, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY WILLIAM GROSSKOFP D.C. (OWNER/CHIROPRACTOR)
(414) 426-9677
Entity
Organization
Contact information
Practice address
11430 W BLUEMOUND RD STE 203, WAUWATOSA, WI 53226-4050
(414) 426-9677
Mailing address
11430 W BLUEMOUND RD STE 203, WAUWATOSA, WI 53226-4050
(414) 426-9677
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4451-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T031020090000051
MEDICARE APPLICATION TRACKING ID
WI
Enumeration date
03/18/2009
Last updated
03/18/2009
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