Provider Demographics
NPI:1578701082
Name:ELITE HEALTH CARE DBA ELITE CHIROPRACTIC AND WELLNESS CENTER
Entity Type:Organization
Organization Name:ELITE HEALTH CARE DBA ELITE CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:ELITE CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-489-6245
Mailing Address - Street 1:23440 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2961
Mailing Address - Country:US
Mailing Address - Phone:503-489-6245
Mailing Address - Fax:503-489-0552
Practice Address - Street 1:23440 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2961
Practice Address - Country:US
Practice Address - Phone:503-489-6245
Practice Address - Fax:503-489-0552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. KENNETH WECKER ELITE HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-22
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1023137585OtherNPI OF PROVIDER
OR1023137585OtherNPI OF PROVIDER