MEDICARE: ELITE CHIROPRACTIC & REHABILITATION, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208100000X	Physical Medicine & Rehabilitation Physician
2	261QM2500X	Medical Specialty Clinic/Center
3	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1871172999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE CHIROPRACTIC & REHABILITATION, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 20007
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-0307
Country	:	US
Telephone Number	:	267-846-2600
Fax Number	:	267-846-2600

Provider Business Practice Location Address
First Line	:	3310 S 20TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-5764
Country	:	US
Telephone Number	:	267-846-2600
Fax Number	:	267-846-2600

Authorized Official
Title or Position	:	OWNER
Name	:	BRITTANY V TOOLE
Credential	:
Telephone Number	:	267-846-2600

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	06/10/2021

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