Healthcare Provider Details

I. General information

NPI: 1407745185
Provider Name (Legal Business Name): ELITE CHIROPRACTIC AND RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

783 BRICK BLVD.
BRICK NJ
08723
US

IV. Provider business mailing address

783 BRICK BLVD.
BRICK NJ
08723
US

V. Phone/Fax

Practice location:
  • Phone: 732-732-3379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLE BILQUIST
Title or Position: OWNER
Credential:
Phone: 732-732-3379