Provider Demographics
NPI:1427411362
Name:ELEVATION HEALTH AND PERFORMANCE PLLC
Entity Type:Organization
Organization Name:ELEVATION HEALTH AND PERFORMANCE PLLC
Other - Org Name:BOULDER SPORTS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN, MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALYX
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-522-8818
Mailing Address - Street 1:3000 CENTER GREEN DR STE 130
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2364
Mailing Address - Country:US
Mailing Address - Phone:303-444-5105
Mailing Address - Fax:
Practice Address - Street 1:3000 CENTER GREEN DR STE 130
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2364
Practice Address - Country:US
Practice Address - Phone:303-444-5105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007297111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO443823YNHUOtherMEDICARE PTAN