MEDICARE: ELITE CHIROPRACTIC CLINIC, INC

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	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1437970225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE CHIROPRACTIC CLINIC, INC

Provider Business Mailing Address
First Line	:	4300 S JOG RD UNIT 540594
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33454-5027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 S JOG RD UNIT 540594
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33454-5027
Country	:	US
Telephone Number	:	786-407-7777
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. SANTIAGO LOPEZ
Credential	:	DC
Telephone Number	:	786-407-7777

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	10/23/2024

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