Provider Demographics
NPI:1891481867
Name:ELEVATION SPINE AND SPORTS MEDICINE PLLC
Entity Type:Organization
Organization Name:ELEVATION SPINE AND SPORTS MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KONNER
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-233-5512
Mailing Address - Street 1:2761 E TRINITY MILLS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-3507
Mailing Address - Country:US
Mailing Address - Phone:214-233-5512
Mailing Address - Fax:
Practice Address - Street 1:2761 E TRINITY MILLS RD STE 100
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3507
Practice Address - Country:US
Practice Address - Phone:214-233-5512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty