Provider Demographics
NPI:1275045080
Name:ELITE HEALTHCARE SOUTHERN UTAH LLC
Entity Type:Organization
Organization Name:ELITE HEALTHCARE SOUTHERN UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-627-0231
Mailing Address - Street 1:3275 E HIDDEN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-1983
Mailing Address - Country:US
Mailing Address - Phone:435-627-0231
Mailing Address - Fax:435-627-0781
Practice Address - Street 1:1490 E FOREMASTER DR STE 260
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4502
Practice Address - Country:US
Practice Address - Phone:435-627-0231
Practice Address - Fax:435-523-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10353222-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty