Provider Demographics
NPI:1023545639
Name:ELITE CHIROPRACTIC LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:ELITE CHIROPRACTIC LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-580-5450
Mailing Address - Street 1:2245 W KOCH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4010
Mailing Address - Country:US
Mailing Address - Phone:406-587-0711
Mailing Address - Fax:
Practice Address - Street 1:2245 W KOCH ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4010
Practice Address - Country:US
Practice Address - Phone:406-587-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty