Provider Demographics
NPI:1881234169
Name:ELITE INJURY PHYSICIANS LLC
Entity type:Organization
Organization Name:ELITE INJURY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:DAMON
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:727-799-2225
Mailing Address - Street 1:4760 E BAY DR STE C
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-5703
Mailing Address - Country:US
Mailing Address - Phone:727-799-2225
Mailing Address - Fax:
Practice Address - Street 1:4760 E BAY DR STE C
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-5703
Practice Address - Country:US
Practice Address - Phone:727-799-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty