Provider Demographics
NPI:1053982959
Name:CORE PERFORMANCE CHIROPRACTIC P.L.L.C.
Entity type:Organization
Organization Name:CORE PERFORMANCE CHIROPRACTIC P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:ST. COEUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-357-7735
Mailing Address - Street 1:1434 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1707
Mailing Address - Country:US
Mailing Address - Phone:810-357-7735
Mailing Address - Fax:
Practice Address - Street 1:401 MCMORRAN BLVD
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3809
Practice Address - Country:US
Practice Address - Phone:810-987-4740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty