MEDICARE: ELITE PERFORMANCE CHIROPRACTIC AND WELLNESS LLC

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	:	1255972675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE PERFORMANCE CHIROPRACTIC AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	11503 SUNSET HILLS RD
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20190-4704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11503 SUNSET HILLS RD
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20190-4704
Country	:	US
Telephone Number	:	703-723-9355
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. SOHEIL CHRISTOPHER RAHBAR
Credential	:	DC
Telephone Number	:	703-723-9355

Provider Enumeration Date	:	10/07/2019
Last Update Date	:	09/03/2021

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