Healthcare Provider Details

I. General information

NPI: 1609485887
Provider Name (Legal Business Name): ELITE INTEGRATED MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 SPRINGBROOK SQUARE DR STE 103
NAPERVILLE IL
60564-5962
US

IV. Provider business mailing address

1999 SPRINGBROOK SQUARE DR STE 103
NAPERVILLE IL
60564-5962
US

V. Phone/Fax

Practice location:
  • Phone: 732-845-6633
  • Fax:
Mailing address:
  • Phone: 732-845-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON P LAMARCHE
Title or Position: OWNER
Credential: DC
Phone: 815-458-2225