Healthcare Provider Details

I. General information

NPI: 1376215871
Provider Name (Legal Business Name): ELITE ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2021
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44427 ATWATER DR STE 130
ASHBURN VA
20147-3423
US

IV. Provider business mailing address

44427 ATWATER DR STE 130
ASHBURN VA
20147-3423
US

V. Phone/Fax

Practice location:
  • Phone: 703-944-2626
  • Fax:
Mailing address:
  • Phone: 703-944-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MCKENNA SMET
Title or Position: OWNER
Credential: MPH, CSCS, CHES
Phone: 301-263-4570