Provider Demographics
NPI:1508491200
Name:ELEVATE WELLNESS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ELEVATE WELLNESS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JURATOVAC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-224-5464
Mailing Address - Street 1:4515 SW CORBETT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4289
Mailing Address - Country:US
Mailing Address - Phone:503-224-5454
Mailing Address - Fax:503-386-2626
Practice Address - Street 1:4515 SW CORBETT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4289
Practice Address - Country:US
Practice Address - Phone:503-224-5454
Practice Address - Fax:503-386-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty