=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346759024
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELITE WELLNESS CHIROPRACTIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13125 BROOKHURST ST
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-591-5478
-----------------------------------------------------
Fax | 714-591-5606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13125 BROOKHURST ST
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843-1079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-591-5478
-----------------------------------------------------
Fax | 714-591-5606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANGAER
-----------------------------------------------------
Name | TRISHA NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-307-8797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | DC27933
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------