Healthcare Provider Details

I. General information

NPI: 1346659794
Provider Name (Legal Business Name): ELITE CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 09/19/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 37TH ST NW
ROCHESTER MN
55901
US

IV. Provider business mailing address

1724 37TH ST NW
ROCHESTER MN
55901
US

V. Phone/Fax

Practice location:
  • Phone: 507-424-1200
  • Fax: 507-288-3249
Mailing address:
  • Phone: 507-424-1200
  • Fax: 507-288-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5959
License Number StateMN

VIII. Authorized Official

Name: WILLIAM CHASE
Title or Position: OWNER
Credential: DC
Phone: 701-880-1125