Provider Demographics
NPI:1639297526
Name:ELITE SPINAL & SPORTS CARE, INC.
Entity Type:Organization
Organization Name:ELITE SPINAL & SPORTS CARE, INC.
Other - Org Name:JUSTIN C. LAU, DC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP, CSCS
Authorized Official - Phone:916-488-4849
Mailing Address - Street 1:2045 HALLMARK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2224
Mailing Address - Country:US
Mailing Address - Phone:916-488-4849
Mailing Address - Fax:916-929-3299
Practice Address - Street 1:2045 HALLMARK DR STE 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2224
Practice Address - Country:US
Practice Address - Phone:916-488-4849
Practice Address - Fax:916-929-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29281111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821074873OtherINDIVIDUAL NPI
CA1821074873OtherINDIVIDUAL NPI