MEDICARE: ELEVATE SPINAL REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1023840501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE SPINAL REHAB

Provider Business Mailing Address
First Line	:	840 PINNACLE CT STE 5A
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89027-3322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 PINNACLE CT STE 5A
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89027-3322
Country	:	US
Telephone Number	:	702-346-5030
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PHILLIP HAMILTON
Credential	:	DC
Telephone Number	:	702-346-5030

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	08/29/2024

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