Provider Demographics
NPI:1588067698
Name:ELITE FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:ELITE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-330-6602
Mailing Address - Street 1:10208 S 168TH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-4185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10208 S 168TH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-4185
Practice Address - Country:US
Practice Address - Phone:620-330-6602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty