Provider Demographics
NPI:1750701553
Name:ELITE PERFORMANCE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ELITE PERFORMANCE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GUITRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-903-0414
Mailing Address - Street 1:W305S6799 COUNTY ROAD I
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9782
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W305S6799 COUNTY ROAD I
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9782
Practice Address - Country:US
Practice Address - Phone:262-903-0414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI443212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty