Provider Demographics
NPI:1124562434
Name:ELITE CAROLINA CHIROPRACTIC
Entity Type:Organization
Organization Name:ELITE CAROLINA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-494-7063
Mailing Address - Street 1:7432 ASHFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-7176
Mailing Address - Country:US
Mailing Address - Phone:815-494-7063
Mailing Address - Fax:
Practice Address - Street 1:1012 MARKET ST
Practice Address - Street 2:STE 101
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6461
Practice Address - Country:US
Practice Address - Phone:803-370-4294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty