Provider Demographics
NPI:1467922799
Name:ELITE SPINE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ELITE SPINE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:GENO
Authorized Official - Last Name:LUPORI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-201-3882
Mailing Address - Street 1:603 RIVERSIDE CHASE CIR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-2521
Mailing Address - Country:US
Mailing Address - Phone:719-201-3882
Mailing Address - Fax:
Practice Address - Street 1:20 CREEKVIEW CT STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4800
Practice Address - Country:US
Practice Address - Phone:864-203-5388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty