Provider Demographics
NPI:1578837712
Name:ELITE CHIROPRACTIC AND MASSAGE, PLLC
Entity Type:Organization
Organization Name:ELITE CHIROPRACTIC AND MASSAGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:B
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-736-5456
Mailing Address - Street 1:8131 W KLAMATH CT
Mailing Address - Street 2:STE H
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5099
Mailing Address - Country:US
Mailing Address - Phone:509-736-5456
Mailing Address - Fax:509-735-9868
Practice Address - Street 1:8131 W KLAMATH CT
Practice Address - Street 2:STE H
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5099
Practice Address - Country:US
Practice Address - Phone:509-736-5456
Practice Address - Fax:509-735-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60025064225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty