Provider Demographics
NPI:1578033965
Name:ELITE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ELITE WELLNESS CENTER LLC
Other - Org Name:BRUCE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIME
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-473-4653
Mailing Address - Street 1:12 GROCE RD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1631
Mailing Address - Country:US
Mailing Address - Phone:864-439-1345
Mailing Address - Fax:864-439-1346
Practice Address - Street 1:12 GROCE RD
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-1631
Practice Address - Country:US
Practice Address - Phone:864-439-1345
Practice Address - Fax:864-439-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty