Provider Demographics
NPI:1326373085
Name:ELITE CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:ELITE CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-741-0018
Mailing Address - Street 1:8357 NW BARRYBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1024
Mailing Address - Country:US
Mailing Address - Phone:816-741-0018
Mailing Address - Fax:816-741-0659
Practice Address - Street 1:8357 NW BARRYBROOKE DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-1024
Practice Address - Country:US
Practice Address - Phone:816-741-0018
Practice Address - Fax:816-741-0659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008003129111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO39742013OtherBLUE CROSS/BLUE SHIELD PROVIDER NUMBER
MOX44000001Medicare PIN