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General NPI Number Information
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NPI Number | 1568889103
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Entity Type | Organization
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Legal Business Name | ELITE SPORTS & WELLNESS LLC
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 03/20/2014
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Provider Practice Location Address
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Address Line | 3586 ALOMA AVE SUITE 8
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City | WINTER PARK
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State | FL
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Zip | 32792-4010
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Country | US
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Telephone | 407-557-3177
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Fax | 407-286-5372
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Provider Business Mailing Address
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Address Line | 3586 ALOMA AVE SUITE 8
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City | WINTER PARK
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State | FL
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Zip | 32792-4010
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Country | US
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Telephone | 407-557-3177
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Fax | 407-286-5372
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. CESAR IRIZARRY
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Credential | D.C.
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Telephone | 407-486-2752
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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 | CH 8448
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License Number State | FL
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