Provider Demographics
NPI:1841026978
Name:ELITE SPORTS MEDICINE AND RECOVERY CENTER
Entity type:Organization
Organization Name:ELITE SPORTS MEDICINE AND RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-213-6983
Mailing Address - Street 1:15510 DERNA TER
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-5507
Mailing Address - Country:US
Mailing Address - Phone:201-213-6983
Mailing Address - Fax:
Practice Address - Street 1:8534 HERITAGE GREEN WAY
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212
Practice Address - Country:US
Practice Address - Phone:201-213-6983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty