Provider Demographics
NPI:1700432721
Name:ELITE CHIROPRACTIC & WELLNESS LLC
Entity Type:Organization
Organization Name:ELITE CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAMARI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ VILLEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-914-4729
Mailing Address - Street 1:LAS VISTAS SHOPPING VILLAGE
Mailing Address - Street 2:300 AVE FELISA RINCON SUITE 9
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-914-4729
Mailing Address - Fax:
Practice Address - Street 1:LAS VISTAS SHOPPING VILLAGE
Practice Address - Street 2:300 AVE FELISA RINCON SUITE 9
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-914-4729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty