Provider Demographics
NPI:1932865409
Name:ELEVATE SPORT AND SPINE, LLC
Entity Type:Organization
Organization Name:ELEVATE SPORT AND SPINE, LLC
Other - Org Name:DR. PRESTON S. DOUGLAS, DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ADINOLFI-PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-239-9122
Mailing Address - Street 1:4012 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2028
Mailing Address - Country:US
Mailing Address - Phone:423-502-3776
Mailing Address - Fax:423-239-7991
Practice Address - Street 1:4012 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2028
Practice Address - Country:US
Practice Address - Phone:423-502-3776
Practice Address - Fax:423-239-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ070613Medicaid