Provider Demographics
NPI:1598302333
Name:ELITE PERFORMANCE WELLNESS CENTER LLC
Entity type:Organization
Organization Name:ELITE PERFORMANCE WELLNESS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NORLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, MMT, MYK, CST
Authorized Official - Phone:541-971-9155
Mailing Address - Street 1:39687 GRIGGS DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-9476
Mailing Address - Country:US
Mailing Address - Phone:541-961-8170
Mailing Address - Fax:
Practice Address - Street 1:33864 SE EASTGATE CIR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-2248
Practice Address - Country:US
Practice Address - Phone:541-961-8170
Practice Address - Fax:541-500-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty