Provider Demographics
NPI:1932572526
Name:NEUROSPORT ELITE, PA
Entity Type:Organization
Organization Name:NEUROSPORT ELITE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LEWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-205-3479
Mailing Address - Street 1:10650 W STATE ROAD 84
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4235
Mailing Address - Country:US
Mailing Address - Phone:954-800-5017
Mailing Address - Fax:954-796-1491
Practice Address - Street 1:10650 W STATE ROAD 84
Practice Address - Street 2:SUITE 111
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4235
Practice Address - Country:US
Practice Address - Phone:954-800-5017
Practice Address - Fax:954-796-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5188111NS0005X
FLCH6275111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty