Elevate Health Chiropractic LLC
Organization Active NPI Chiropractor · South Burlington, VT
NPI 1376945147 · NPPES record last updated Oct 24, 2014
Key facts
- NPI
- 1376945147
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 006.0001179 (VT)
- Legal business name
- ELEVATE HEALTH CHIROPRACTIC LLC
- Practice address
- 595 Dorset St Ste 8
South Burlington, VT 05403-6240 - Phone
- (802) 557-8568
- NPI assigned
- Sep 23, 2014
- Organization subpart
- No
Authorized official
- Name
- Paul M Samuel, D.C.
- Title
- Registered Agent
- Phone
- (802) 318-7835
Practitioners 1
-
Paul M Samuel, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150106000389 | VT | Part B Supplier - Clinic/Group Practice | 7416270020 |
Receives reassigned benefits from 1 practitioner Practice locations: South Burlington, VT |
National Provider Directory
Locations
595 Dorset St
Ste 8
South Burlington, VT 05403
Phone (802) 557-8568
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 006.0001179 | VT | Yes |
Addresses
Primary practice location
595 Dorset St Ste 8
South Burlington, VT 05403-6240
Mailing address
595 Dorset St Ste 8
South Burlington, VT 05403-6240
Phone (802) 557-8568
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1021668 | Medicaid | VT |
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All providers in South Burlington, VT · Chiropractor in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.