Healthcare Provider Details

I. General information

NPI: 1508001488
Provider Name (Legal Business Name): ELITE 24 HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S. WALDRON RD. SUITE 155
FT. SMITH AR
72903
US

IV. Provider business mailing address

P.O. BOX 10585
FT. SMITH AR
72917
US

V. Phone/Fax

Practice location:
  • Phone: 479-452-0031
  • Fax: 479-452-0034
Mailing address:
  • Phone: 479-452-0031
  • Fax: 479-452-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERRY ANN EZELL
Title or Position: CLINIC OWNER
Credential: LMT, NMT, MMP
Phone: 479-452-0031