Provider Demographics
NPI:1699201376
Name:ELITE SPINE & JOINT, PLLC
Entity Type:Organization
Organization Name:ELITE SPINE & JOINT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DYLAN
Authorized Official - Last Name:MACHYCEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-653-2225
Mailing Address - Street 1:3309 WINCHESTER
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-2896
Mailing Address - Country:US
Mailing Address - Phone:501-575-0271
Mailing Address - Fax:501-575-0274
Practice Address - Street 1:3309 WINCHESTER
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2896
Practice Address - Country:US
Practice Address - Phone:501-575-0271
Practice Address - Fax:501-575-0274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16155261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR16155OtherCHIROPRACTIC LICENSE NO.