Provider Demographics
NPI:1992111686
Name:TROSS ELITE GOLF PERFORMANCE AND WELLNESS LLC
Entity type:Organization
Organization Name:TROSS ELITE GOLF PERFORMANCE AND WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-313-6631
Mailing Address - Street 1:5055 HIGHWAY N STE 108
Mailing Address - Street 2:
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8031
Mailing Address - Country:US
Mailing Address - Phone:636-706-6171
Mailing Address - Fax:
Practice Address - Street 1:5055 HIGHWAY N STE 108
Practice Address - Street 2:
Practice Address - City:COTTLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63304-8031
Practice Address - Country:US
Practice Address - Phone:314-313-6631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014018403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty