Provider Demographics
NPI:1760006712
Name:ELITE INTEGRATIVE MEDICAL
Entity Type:Organization
Organization Name:ELITE INTEGRATIVE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:BERK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-888-8896
Mailing Address - Street 1:153 S DOHENY DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2509
Mailing Address - Country:US
Mailing Address - Phone:310-888-8896
Mailing Address - Fax:
Practice Address - Street 1:153 S DOHENY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2509
Practice Address - Country:US
Practice Address - Phone:310-888-8896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERK CHIROPRACTIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-05
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty