Provider Demographics
NPI:1881367357
Name:ELEVATED LIVING CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ELEVATED LIVING CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-819-9549
Mailing Address - Street 1:36234 535 AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT EDWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68660-6055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 GRANT ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-3200
Practice Address - Country:US
Practice Address - Phone:402-819-9549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026880900Medicaid