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General NPI Number Information
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NPI Number | 1225534829
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Entity Type | Organization
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Legal Business Name | ELITE CHIROPRACTIC AND PERFORMANCE, LLC
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 140 LONG RD STE 201
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City | CHESTERFIELD
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State | MO
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Zip | 63005-1282
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Country | US
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Telephone | 636-728-8607
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Fax | 314-400-2204
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Provider Business Mailing Address
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Address Line | 140 LONG RD STE 201
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City | CHESTERFIELD
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State | MO
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Zip | 63005-1282
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Country | US
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Telephone | 636-728-8607
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARTIN C COLLIER
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Credential | DC
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Telephone | 636-728-6607
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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 | 2014002436
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License Number State | MO
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