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General NPI Number Information
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NPI Number | 1568069805
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Entity Type | Organization
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Legal Business Name | ELITE SPINE & WELLNESS CENTER, INC
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Dates
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Enumeration Date | 10/08/2020
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 6833 STALTER DR STE 203
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City | ROCKFORD
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State | IL
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Zip | 61108-2582
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Country | US
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Telephone | 815-904-6650
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Fax | 815-904-6564
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Provider Business Mailing Address
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Address Line | 6833 STALTER DR STE 203
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City | ROCKFORD
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State | IL
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Zip | 61108-2582
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Country | US
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Telephone | 815-904-6650
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRITTANY SULLIVAN
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Credential | DC
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Telephone | 181-598-8783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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