Provider Demographics
NPI:1841594900
Name:ELITE SPECIALTY CLINICS, INC.
Entity Type:Organization
Organization Name:ELITE SPECIALTY CLINICS, INC.
Other - Org Name:ELITE HEALTH & FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HAUG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:701-770-0906
Mailing Address - Street 1:512 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5316
Mailing Address - Country:US
Mailing Address - Phone:701-774-0320
Mailing Address - Fax:
Practice Address - Street 1:512 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5316
Practice Address - Country:US
Practice Address - Phone:701-774-0320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1089261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy