Organization
PERFORMANCE HEALTH CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MIRANDA LEIGH DAVIS (PROPRIETOR)
(636) 219-9664
Entity
Organization
Contact information
Practice address
3641 REAVIS BARRACKS RD, SAINT LOUIS, MO 63125-2438
(636) 219-9664
Mailing address
3641 REAVIS BARRACKS RD, SAINT LOUIS, MO 63125-2438
(636) 219-9664
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
038011404
MO
Other
Enumeration date
08/23/2010
Last updated
08/23/2010
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