Provider Demographics
NPI:1700161577
Name:ELEVATED HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:ELEVATED HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-643-2020
Mailing Address - Street 1:195 E GENTILE ST STE 7
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3754
Mailing Address - Country:US
Mailing Address - Phone:801-643-2020
Mailing Address - Fax:801-546-0966
Practice Address - Street 1:195 E GENTILE ST STE 7
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-3754
Practice Address - Country:US
Practice Address - Phone:801-643-2020
Practice Address - Fax:801-546-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8062892-12020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000075052OtherELEVATED HEALTH AND WELLNESS PTAN
UTU000075051OtherBRAD MILLER PTAN