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General NPI Number Information
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NPI Number | 1437970225
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Entity Type | Organization
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Legal Business Name | ELITE CHIROPRACTIC CLINIC, INC
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 4300 S JOG RD UNIT 540594
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City | GREENACRES
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State | FL
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Zip | 33454-5027
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Country | US
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Telephone | 786-407-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 S JOG RD UNIT 540594
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City | GREENACRES
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State | FL
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Zip | 33454-5027
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SANTIAGO LOPEZ
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Credential | DC
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Telephone | 786-407-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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