Provider Demographics
NPI:1578076642
Name:ELEVATE CHIROPRACTIC & WELLNESS CENTER
Entity Type:Organization
Organization Name:ELEVATE CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ROSEVEAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-537-0261
Mailing Address - Street 1:1129 ARMSTRONG MILL RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3106
Mailing Address - Country:US
Mailing Address - Phone:859-537-0261
Mailing Address - Fax:
Practice Address - Street 1:4250 SARON DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6483
Practice Address - Country:US
Practice Address - Phone:859-629-3131
Practice Address - Fax:859-629-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100069880Medicaid