Provider Demographics
NPI:1639643240
Name:ELEVATE LIFE MEDICAL PLLC
Entity Type:Organization
Organization Name:ELEVATE LIFE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DADUFALZA-SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-334-6512
Mailing Address - Street 1:1604 ARBORCREEK TRL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5434
Mailing Address - Country:US
Mailing Address - Phone:214-334-6512
Mailing Address - Fax:
Practice Address - Street 1:805 WASHINGTON DR STE F
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2528
Practice Address - Country:US
Practice Address - Phone:214-334-6512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty