Provider Demographics
NPI:1164655213
Name:ELITE PERFORMANCE CHIROPRACTIC
Entity Type:Organization
Organization Name:ELITE PERFORMANCE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GUNDLACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-335-6400
Mailing Address - Street 1:3530 S VAL VISTA DR # A111
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7318
Mailing Address - Country:US
Mailing Address - Phone:480-448-6842
Mailing Address - Fax:480-812-9040
Practice Address - Street 1:3530 S VAL VISTA DR # A111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:480-448-6842
Practice Address - Fax:480-393-8289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty