Provider Demographics
NPI:1669005419
Name:ELITE CORRECTIONS CHIROPRACTIC
Entity type:Organization
Organization Name:ELITE CORRECTIONS CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAKEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-621-1667
Mailing Address - Street 1:1893 E SKYLINE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5228
Mailing Address - Country:US
Mailing Address - Phone:801-621-1667
Mailing Address - Fax:801-605-3807
Practice Address - Street 1:1893 E SKYLINE DR STE 204
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5228
Practice Address - Country:US
Practice Address - Phone:801-621-1667
Practice Address - Fax:801-605-3807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty