Provider Demographics
NPI:1194261750
Name:ELITE PERFORMANCE & INDIVIDUALIZED CARE CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:ELITE PERFORMANCE & INDIVIDUALIZED CARE CHIROPRACTIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMEBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-255-3777
Mailing Address - Street 1:1300 E NEW CIRCLE RD
Mailing Address - Street 2:STE. 160
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505
Mailing Address - Country:US
Mailing Address - Phone:859-255-3777
Mailing Address - Fax:859-255-3967
Practice Address - Street 1:1300 E NEW CIRCLE RD STE 160
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505
Practice Address - Country:US
Practice Address - Phone:859-255-3777
Practice Address - Fax:859-255-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty