NPIMap

Organization Active NPI

Performance Chiropractic PLLC

  • Chiropractor
  • Grand Forks, ND
National Provider Identifier
1720237258
Registry record updated Jan 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
798 Issued in ND
Legal business name
PERFORMANCE CHIROPRACTIC PLLC
Practice address
4350 S Washington St
Suite 100
Grand Forks, ND 58201-7184
Phone
(701) 732-2888
Fax
(701) 732-2711
NPI assigned
Sep 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2015

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

Authorized official

Name
Dr. Stacy Lane Hallgren, DC, CCEP, CSTNPI 1407036627
Title
Chiropractor/Owner
Phone
(701) 732-2888

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 798 ND Primary

Addresses

Primary practice location

4350 S Washington St
Suite 100
Grand Forks, ND 58201-7184

Mailing address

4350 S Washington St
Suite 100
Grand Forks, ND 58201-7184
Phone (701) 732-2888

Other identifiers 3

IdentifierTypeStateIssuer
14609MedicaidND
1407036627MedicaidMN
713023OtherNDPTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081009000103 ND Part B Supplier - Clinic/Group Practice 3779651336 Receives reassigned benefits from 2 practitioners
Practice locations: Grand Forks, ND

National Provider Directory

National Provider Directory

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": "1220918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420761600000",
    "number": "1720237258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350 S WASHINGTON ST",
            "address_2": "SUITE 100",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582017184",
            "telephone_number": "701-732-2888",
            "fax_number": "701-732-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 S WASHINGTON ST",
            "address_2": "SUITE 100",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582017184",
            "telephone_number": "701-732-2888",
            "fax_number": "701-732-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-09",
        "last_updated": "2015-01-09",
        "status": "A",
        "authorized_official_last_name": "HALLGREN",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "LANE",
        "authorized_official_title_or_position": "CHIROPRACTOR/OWNER",
        "authorized_official_telephone_number": "701-732-2888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC, CCEP, CST"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "ND",
            "license": "798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14609",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407036627",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "713023",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.