Provider Demographics
NPI:1427368976
Name:ELITE HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:ELITE HEALTH AND WELLNESS, LLC
Other - Org Name:ELITE HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SOEHREN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:760-771-5450
Mailing Address - Street 1:79245 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7247
Mailing Address - Country:US
Mailing Address - Phone:760-771-5450
Mailing Address - Fax:760-771-5102
Practice Address - Street 1:79245 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7247
Practice Address - Country:US
Practice Address - Phone:760-771-5450
Practice Address - Fax:760-771-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30014111N00000X
CARHC 166643111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty