Provider Demographics
NPI:1437492584
Name:ELITE CHIROPRACTIC AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ELITE CHIROPRACTIC AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:RAISHART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-687-7011
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-0936
Mailing Address - Country:US
Mailing Address - Phone:724-687-7011
Mailing Address - Fax:724-687-7012
Practice Address - Street 1:100 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046
Practice Address - Country:US
Practice Address - Phone:724-687-7011
Practice Address - Fax:724-687-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000171984OtherUNISON
PA0018874400001Medicaid
PA3653462OtherCIGNA
PARA623901OtherBCBS
PA3653462OtherCIGNA
PARA623901OtherBCBS