Provider Demographics
NPI:1508001488
Name:ELITE 24 HEALTH GROUP
Entity Type:Organization
Organization Name:ELITE 24 HEALTH GROUP
Other - Org Name:ELITE 24 HEALTH CLUB/CHIROPRACTIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EZELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NMT, MMP
Authorized Official - Phone:479-452-0031
Mailing Address - Street 1:P.O. BOX 10585
Mailing Address - Street 2:
Mailing Address - City:FT. SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917
Mailing Address - Country:US
Mailing Address - Phone:479-452-0031
Mailing Address - Fax:479-452-0034
Practice Address - Street 1:1200 S. WALDRON RD.
Practice Address - Street 2:SUITE 155
Practice Address - City:FT. SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903
Practice Address - Country:US
Practice Address - Phone:479-452-0031
Practice Address - Fax:479-452-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty