Provider Demographics
NPI:1013553189
Name:ELITE UPPER CERVICAL LLC
Entity Type:Organization
Organization Name:ELITE UPPER CERVICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-597-8098
Mailing Address - Street 1:10200 SW EASTRIDGE ST STE 235
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5063
Mailing Address - Country:US
Mailing Address - Phone:503-597-8098
Mailing Address - Fax:503-597-8098
Practice Address - Street 1:10200 SW EASTRIDGE ST STE 235
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5063
Practice Address - Country:US
Practice Address - Phone:503-597-8098
Practice Address - Fax:503-597-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty