Provider Demographics
NPI:1962013102
Name:ELITE PERFORMANCE WINSTON PLLC
Entity Type:Organization
Organization Name:ELITE PERFORMANCE WINSTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:REA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-617-8113
Mailing Address - Street 1:1901 WESTRIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2425
Mailing Address - Country:US
Mailing Address - Phone:336-617-8113
Mailing Address - Fax:336-617-8190
Practice Address - Street 1:2544 SOMERSET CENTER DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6766
Practice Address - Country:US
Practice Address - Phone:336-617-9890
Practice Address - Fax:336-955-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty