Provider Demographics
NPI:1639355175
Name:ELITE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ELITE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TONER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-628-9200
Mailing Address - Street 1:9 EAGLE CTR
Mailing Address - Street 2:STE. 1
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1948
Mailing Address - Country:US
Mailing Address - Phone:618-628-9200
Mailing Address - Fax:
Practice Address - Street 1:9 EAGLE CTR
Practice Address - Street 2:STE. 1
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1948
Practice Address - Country:US
Practice Address - Phone:618-628-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty