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General NPI Number Information
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NPI Number | 1457904492
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Entity Type | Organization
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Legal Business Name | ELITE CHIROPRACTIC GROUP
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 220 NW 8TH AVE
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City | PORTLAND
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State | OR
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Zip | 97209
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Country | US
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Telephone | 360-843-9028
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Fax | 503-336-1033
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Provider Business Mailing Address
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Address Line | 865 NE TOMAHAWK ISLAND DR STE 102
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City | PORTLAND
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State | OR
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Zip | 97217-8095
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Country | US
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Telephone | 360-843-9028
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Fax | 503-336-1033
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Authorized Official
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Title or Position | PARTNER
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Name | RICHARD ROGACHEVSKY
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Credential | DC
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Telephone | 360-843-9028
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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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