MEDICARE: ELITE PHYSICAL MEDICINE

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	12049	TX

General Provider Information

NPI Number	:	1871963025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE PHYSICAL MEDICINE

Provider Business Mailing Address
First Line	:	2535 TYE LN
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75056-3936
Country	:	US
Telephone Number	:	972-339-2464
Fax Number	:

Provider Business Practice Location Address
First Line	:	2711 N HASKELL AVE
Second Line	:	2ND FLOOR
City	:	DALLAS
State	:	TX
Zip	:	75204-2911
Country	:	US
Telephone Number	:	972-885-0440
Fax Number	:	888-317-7686

Authorized Official
Title or Position	:	DIRECTOR OF PHYSICAL MEDICINE
Name	:	BRADLEY ALLEN HALL
Credential	:	D.C.
Telephone Number	:	972-339-2464

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	09/30/2015

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Directions to “ELITE PHYSICAL MEDICINE ” Practice Location

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