Healthcare Provider Details

I. General information

NPI: 1295431302
Provider Name (Legal Business Name): ELEVATE FAMILY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 04/25/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 NORTHLAND DR NE STE B
GRAND RAPIDS MI
49525-1081
US

IV. Provider business mailing address

5150 NORTHLAND DR NE STE B
GRAND RAPIDS MI
49525-1081
US

V. Phone/Fax

Practice location:
  • Phone: 616-314-7616
  • Fax:
Mailing address:
  • Phone: 616-314-7616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALICIA ASHTON-MAYER
Title or Position: AO/PROVIDER/OWNER
Credential: DC
Phone: 734-776-2026