Provider Demographics
NPI:1679168165
Name:ELITE HEALTH OF NORTH AUSTIN
Entity type:Organization
Organization Name:ELITE HEALTH OF NORTH AUSTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-866-9476
Mailing Address - Street 1:12233 RANCH ROAD 620 N STE 107
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1068
Mailing Address - Country:US
Mailing Address - Phone:512-331-9999
Mailing Address - Fax:
Practice Address - Street 1:12233 RANCH ROAD 620 N STE 107
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1068
Practice Address - Country:US
Practice Address - Phone:512-331-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE HEALTH OF NORTH AUSTIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty