Provider Demographics
NPI:1255565578
Name:ELITE MEDICAL AND REHAB CENTER
Entity type:Organization
Organization Name:ELITE MEDICAL AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WAJNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-447-6848
Mailing Address - Street 1:5949 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3444
Mailing Address - Country:US
Mailing Address - Phone:407-447-6848
Mailing Address - Fax:407-447-6849
Practice Address - Street 1:5949 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3444
Practice Address - Country:US
Practice Address - Phone:407-447-6848
Practice Address - Fax:407-447-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty