Healthcare Provider Details

I. General information

NPI: 1003665217
Provider Name (Legal Business Name): ELITE CHIROPRACTIC AND SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12725 W INDIAN SCHOOL RD STE B103
AVONDALE AZ
85392-9522
US

IV. Provider business mailing address

12725 W INDIAN SCHOOL RD STE B103
AVONDALE AZ
85392-9522
US

V. Phone/Fax

Practice location:
  • Phone: 623-250-3070
  • Fax: 602-313-3228
Mailing address:
  • Phone: 623-250-3070
  • Fax: 602-313-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD ALEXANDER SWARTZ
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 623-250-3070