1790165215 NPI number — PERFORMANCE CHIROPRACTIC & SPORTS MEDICINE

Table of content: BRANDON SCOTT SHEEHY PHARM.D. (NPI 1700776762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790165215 NPI number — PERFORMANCE CHIROPRACTIC & SPORTS MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERFORMANCE CHIROPRACTIC & SPORTS MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790165215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6001 WINDHAVEN PKWY
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-8017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-473-8980
Provider Business Mailing Address Fax Number:
972-212-6851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6001 WINDHAVEN PKWY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-8017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-473-8980
Provider Business Practice Location Address Fax Number:
972-212-6851
Provider Enumeration Date:
06/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DARDEN
Authorized Official First Name:
COURTNEY
Authorized Official Middle Name:
TEAL
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
972-473-8980

Provider Taxonomy Codes

  • Taxonomy code: 111NX0800X , with the licence number:  F0010135 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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