Provider Demographics
NPI:1619406147
Name:ELEVATION HEALTH HIGHLAND VILLAGE, LLC
Entity Type:Organization
Organization Name:ELEVATION HEALTH HIGHLAND VILLAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-697-2560
Mailing Address - Street 1:7948 DAVIS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-6953
Mailing Address - Country:US
Mailing Address - Phone:817-697-2560
Mailing Address - Fax:817-577-2345
Practice Address - Street 1:2150 JUSTIN RD STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7126
Practice Address - Country:US
Practice Address - Phone:469-763-3221
Practice Address - Fax:469-763-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1851829774OtherINDIVIDUAL NPI