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General NPI Number Information
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NPI Number | 1598302333
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Entity Type | Organization
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Legal Business Name | ELITE PERFORMANCE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 11/27/2019
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 33864 SE EASTGATE CIR
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City | CORVALLIS
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State | OR
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Zip | 97333-2248
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Country | US
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Telephone | 541-961-8170
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Fax | 541-500-0884
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Provider Business Mailing Address
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Address Line | 39687 GRIGGS DR
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City | LEBANON
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State | OR
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Zip | 97355-9476
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Country | US
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Telephone | 541-961-8170
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HEATHER NORLANDER
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Credential | LMT, MMT, MYK, CST
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Telephone | 541-971-9155
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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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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 226300000X
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Taxonomy Name | Kinesiotherapist
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License Number |
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License Number State |
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