Organization
PERFORMANCE CHIROPRACTIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACY LANE HALLGREN DC, CCEP, CST (CHIROPRACTOR/OWNER)
(701) 732-2888
Entity
Organization
Contact information
Practice address
4350 S WASHINGTON ST, SUITE 100, GRAND FORKS, ND 58201-7184
(701) 732-2888
(701) 732-2711
Mailing address
4350 S WASHINGTON ST, SUITE 100, GRAND FORKS, ND 58201-7184
(701) 732-2888
(701) 732-2711
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
798
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407036627
—
MN
05
—
14609
—
ND
01
—
713023
PTAN
ND
Enumeration date
09/09/2008
Last updated
01/09/2015
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