Provider Demographics
NPI:1851647622
Name:ELITE TOTAL REHAB, LLC
Entity Type:Organization
Organization Name:ELITE TOTAL REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-763-2387
Mailing Address - Street 1:7008 W HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1902
Mailing Address - Country:US
Mailing Address - Phone:773-763-2387
Mailing Address - Fax:773-763-0562
Practice Address - Street 1:7008 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1902
Practice Address - Country:US
Practice Address - Phone:773-763-2387
Practice Address - Fax:773-763-0562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
038-010161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty