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NPI Code Detail

MEDICARE: ELITE SPORT & SPINE, LLC

MEDICARE: ELITE SPORT & SPINE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist
2111N00000XChiropractor4968-12WI

General Provider Information

NPI Number : 1053740803
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELITE SPORT & SPINE, LLC
Provider Business Mailing Address
First Line : 20900 SWENSON DR STE 575
Second Line :
City : WAUKESHA
State : WI
Zip : 53186-4040
Country : US
Telephone Number : 262-373-9168
Fax Number : 262-226-8383
Provider Business Practice Location Address
First Line : 20900 SWENSON DR STE 575
Second Line :
City : WAUKESHA
State : WI
Zip : 53186-4040
Country : US
Telephone Number : 262-373-9168
Fax Number : 262-226-8383
Authorized Official
Title or Position : OWNER/DOCTOR OF CHIROPRACTIC
Name : DR. ZACH SHIELS
Credential : DC
Telephone Number : 262-373-9168
Provider Enumeration Date : 11/02/2013
Last Update Date : 06/08/2026

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Directions to “ELITE SPORT & SPINE, LLC ” Practice Location

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