Provider Demographics
NPI:1366100380
Name:ELEVATE LIFE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ELEVATE LIFE CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HURD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-427-5244
Mailing Address - Street 1:2004 NW SOUTH OUTER RD
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-6423
Mailing Address - Country:US
Mailing Address - Phone:816-427-5244
Mailing Address - Fax:816-427-5245
Practice Address - Street 1:2004 NW SOUTH OUTER RD
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-6423
Practice Address - Country:US
Practice Address - Phone:816-427-5244
Practice Address - Fax:816-427-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1194483420OtherNPI