MEDICARE: ELITE CHIROPRACTIC & WELLNESS CENTER

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	CD32573	CA

General Provider Information

NPI Number	:	1679918437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE CHIROPRACTIC & WELLNESS CENTER

Provider Business Mailing Address
First Line	:	8920 WILSHIRE BLVD STE 610
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2006
Country	:	US
Telephone Number	:	310-666-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	8920 WILSHIRE BLVD STE 610
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2006
Country	:	US
Telephone Number	:	310-666-2776
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. JAMIE MAHTABAN
Credential	:	DC
Telephone Number	:	310-666-2776

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	09/13/2024

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