Provider Demographics
NPI:1073936480
Name:ELITE PERFORMANCE INSITUTE LLC
Entity Type:Organization
Organization Name:ELITE PERFORMANCE INSITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC MS
Authorized Official - Phone:331-472-4326
Mailing Address - Street 1:1112 S WASHINGTON ST
Mailing Address - Street 2:SUITE 114A
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7959
Mailing Address - Country:US
Mailing Address - Phone:331-472-4326
Mailing Address - Fax:
Practice Address - Street 1:1112 S WASHINGTON ST
Practice Address - Street 2:SUITE 114A
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7959
Practice Address - Country:US
Practice Address - Phone:331-472-4326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty