Provider Demographics
NPI:1962632182
Name:ELITE WELLNESS CHIROPRACTIC & ACUPUNCTURE
Entity Type:Organization
Organization Name:ELITE WELLNESS CHIROPRACTIC & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:519-297-2288
Mailing Address - Street 1:12101 FM 2244 RD STE 5B
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6464
Mailing Address - Country:US
Mailing Address - Phone:512-297-2288
Mailing Address - Fax:512-297-2588
Practice Address - Street 1:12101 FM 2244 RD STE 5B
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6464
Practice Address - Country:US
Practice Address - Phone:512-297-2288
Practice Address - Fax:512-297-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty