Provider Demographics
NPI:1679918437
Name:ELITE CHIROPRACTIC & WELLNESS CENTER
Entity type:Organization
Organization Name:ELITE CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHTABAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-666-2776
Mailing Address - Street 1:8920 WILSHIRE BLVD STE 610
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2006
Mailing Address - Country:US
Mailing Address - Phone:310-666-2776
Mailing Address - Fax:
Practice Address - Street 1:8920 WILSHIRE BLVD STE 610
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2006
Practice Address - Country:US
Practice Address - Phone:310-666-2776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACD32573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty