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General NPI Number Information
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NPI Number | 1053129320
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Entity Type | Organization
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Legal Business Name | ELEVATE CHIROPRACTIC & WELLNESS
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 70 SCHANCK RD
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City | FREEHOLD
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State | NJ
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Zip | 07728-5309
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Country | US
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Telephone | 732-330-5305
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Fax |
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Provider Business Mailing Address
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Address Line | 20 SUN HOLLOW RD
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City | HOWELL
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State | NJ
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Zip | 07731-1865
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Country | US
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Telephone | 732-330-5305
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Fax |
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Authorized Official
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Title or Position | OWNER / CEO
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Name | TYLER JORDAN DIGIOVANNI
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Credential | DC
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Telephone | 732-330-5305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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