Provider Demographics
NPI:1386465722
Name:ELEVATE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ELEVATE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC; HEAD DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-442-6025
Mailing Address - Street 1:9610 LIMA ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818
Mailing Address - Country:US
Mailing Address - Phone:260-209-5568
Mailing Address - Fax:
Practice Address - Street 1:9610 LIMA ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818
Practice Address - Country:US
Practice Address - Phone:260-209-5568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty