Provider Demographics
NPI:1275875288
Name:ELITE CHIROPRACTIC & SPORTS REHAB LLC
Entity Type:Organization
Organization Name:ELITE CHIROPRACTIC & SPORTS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-895-3085
Mailing Address - Street 1:17941 US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6717
Mailing Address - Country:US
Mailing Address - Phone:352-729-5105
Mailing Address - Fax:866-645-7329
Practice Address - Street 1:17941 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6717
Practice Address - Country:US
Practice Address - Phone:352-729-5105
Practice Address - Fax:866-645-7329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty