NPIMap

Organization Active NPI

Performance Chiropractic and Sports Clinic

  • Chiropractor
  • Grand Rapids, MN
National Provider Identifier
1487745477
Registry record updated Oct 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
PERFORMANCE CHIROPRACTIC AND SPORTS CLINIC
Practice address
104 NE 3Rd St
Suite 220
Grand Rapids, MN 55744
Phone
(218) 326-0604
Fax
(218) 326-1509
NPI assigned
Sep 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Adam Zachman, DCNPI 1821361163
Title
Owner
Phone
(218) 326-0604

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 4472 MN
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X MN Primary

Addresses

Primary practice location

104 NE 3Rd St
Suite 220
Grand Rapids, MN 55744

Mailing address

104 NE 3Rd St
Suite 220
Grand Rapids, MN 55744
Phone (218) 326-0604

Other identifiers 1

IdentifierTypeStateIssuer
120187500MedicaidMN

Other names 1

  • Performance Chiropractic and Soft Tissue Clinic Former legal business name

National Provider Directory

National Provider Directory

Locations

104 NE 3rd St
Ste 220
Grand Rapids, MN 55744
Phone (218) 301-7226

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383177600000",
    "number": "1487745477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 NE 3RD ST",
            "address_2": "SUITE 220",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "55744",
            "telephone_number": "218-326-0604",
            "fax_number": "218-326-1509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 NE 3RD ST",
            "address_2": "SUITE 220",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "55744",
            "telephone_number": "218-326-0604",
            "fax_number": "218-326-1509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE CHIROPRACTIC AND SPORTS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2013-10-31",
        "status": "A",
        "authorized_official_last_name": "ZACHMAN",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-326-0604",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4472",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120187500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Performance Chiropractic and Soft Tissue Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Grand Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.