Provider Demographics
NPI:1306155510
Name:ELITE SPORTS CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ELITE SPORTS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-337-5757
Mailing Address - Street 1:7570 W 21ST ST N STE 1006A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1773
Mailing Address - Country:US
Mailing Address - Phone:316-337-5757
Mailing Address - Fax:316-337-5758
Practice Address - Street 1:7570 W 21ST ST N STE 1006A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1773
Practice Address - Country:US
Practice Address - Phone:316-337-5757
Practice Address - Fax:316-337-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2023-07-06
Deactivation Date:2023-06-23
Deactivation Code:
Reactivation Date:2023-07-06
Provider Licenses
StateLicense IDTaxonomies
KS01-05124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty