Provider Demographics
NPI:1053616656
Name:ELITECARE CENTER, LLC
Entity type:Organization
Organization Name:ELITECARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTOR OF ESTATE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:NIEHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-877-8992
Mailing Address - Street 1:2870 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3234
Mailing Address - Country:US
Mailing Address - Phone:217-877-8992
Mailing Address - Fax:217-877-8978
Practice Address - Street 1:2870 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3234
Practice Address - Country:US
Practice Address - Phone:217-877-8992
Practice Address - Fax:217-877-8978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL344604179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty