Provider Demographics
NPI:1043405202
Name:ELITE CHIRO PC
Entity Type:Organization
Organization Name:ELITE CHIRO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VLAD
Authorized Official - Middle Name:
Authorized Official - Last Name:POGILDAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-318-0784
Mailing Address - Street 1:3-16 28TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3848
Mailing Address - Country:US
Mailing Address - Phone:917-318-0784
Mailing Address - Fax:
Practice Address - Street 1:49 MORTON PL
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-1605
Practice Address - Country:US
Practice Address - Phone:917-318-0784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00612000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099760XHWMedicare PIN
NJ119229Medicare PIN