Provider Demographics
NPI:1427826056
Name:ELITE SPINE & SPORT LLC
Entity type:Organization
Organization Name:ELITE SPINE & SPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-264-0940
Mailing Address - Street 1:310 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2213
Mailing Address - Country:US
Mailing Address - Phone:217-264-0940
Mailing Address - Fax:
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-2437
Practice Address - Country:US
Practice Address - Phone:765-505-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy