MEDICARE: ELEVATION CHIROPRACTIC & WELLNESS

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
1	111N00000X	Chiropractor	5035	MN

General Provider Information

NPI Number	:	1437535853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATION CHIROPRACTIC & WELLNESS

Provider Business Mailing Address
First Line	:	5615 22ND AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55417-2701
Country	:	US
Telephone Number	:	612-500-9182
Fax Number	:

Provider Business Practice Location Address
First Line	:	5415 NICOLLET AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55419-1927
Country	:	US
Telephone Number	:	612-500-9182
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. ADAM DAVID LILLA
Credential	:	D.C.
Telephone Number	:	612-500-9182

Provider Enumeration Date	:	08/07/2015
Last Update Date	:	08/07/2015

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