Provider Demographics
NPI:1194160846
Name:ELEVATION HEALTH NORTH RICHLAND
Entity type:Organization
Organization Name:ELEVATION HEALTH NORTH RICHLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LABRECQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-577-6061
Mailing Address - Street 1:7948 DAVIS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-6954
Mailing Address - Country:US
Mailing Address - Phone:817-697-2560
Mailing Address - Fax:
Practice Address - Street 1:7948 DAVIS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-6954
Practice Address - Country:US
Practice Address - Phone:817-697-2560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEXAGON HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-08
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00196TOtherMEDICARE PTAN