Elite Spine LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

CH12049 Issued in FL

Legal business name

ELITE SPINE LLC

Practice address

800 Dunlawton Ave Ste 103
Port Orange, FL 32127-4249

Phone

(386) 265-0102

Fax

(386) 401-2316

NPI assigned

Sep 14, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rachel Nakayama

Title

Owner

Phone

(386) 872-2929

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Luke Barkley

  • Chiropractor
  • Port Orange, FL
  • NPI 1942093414
  NPD
• Millan Miguel Garcia, DC

  • Chiropractor
  • Port Orange, FL
  • NPI 1851186373

  Single Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633305600000",
    "number": "1639698269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 DUNLAWTON AVE STE 103",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274249",
            "telephone_number": "386-265-0102",
            "fax_number": "386-401-2316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 DUNLAWTON AVE STE 103",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274249",
            "telephone_number": "386-265-0102",
            "fax_number": "386-401-2316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE SPINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-14",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A",
        "authorized_official_last_name": "NAKAYAMA",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-872-2929"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "FL",
            "license": "CH12049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295271344",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edward Merkle (Counseling-Therapy of New Smyrna Port Orange Daytona)
• Devaughn Edwards, RBT
• Lori Katherine Ehmann, OTR
• Valerie Eitel
• El Kebeer
• Elizabeth Daquila MD, LLC
• Elizabeth Lee OD PA
• Sara Elliott, LMHC
• Amy Louise Ellis, PT
• Aaron Ellman

• Medical Specialty Clinic/Center in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Medical Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.