MEDICARE: VIDA ELITE PLLC

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	:	1871452334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDA ELITE PLLC

Provider Business Mailing Address
First Line	:	1800 PRESTON PARK BLVD STE 104
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5157
Country	:	US
Telephone Number	:	832-680-1331
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 PRESTON PARK BLVD STE 104
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5157
Country	:	US
Telephone Number	:	832-680-1331
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAOLA MICHELLE ORTIZ CASTRO
Credential	:
Telephone Number	:	832-680-1331

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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