Elevate Sport and Spine, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

ELEVATE SPORT AND SPINE, LLC

Practice address

101 Professional Park PVT Dr
Kingsport, TN 37663-2288

Phone

(423) 239-9122

Fax

(423) 239-7991

NPI assigned

Nov 9, 2021

Organization subpart

No

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

Authorized official

Name

Preston S Douglas, DC, CCSP, ATCNPI 1922696780

Title

Owner/Ceo/Chiropractor

Phone

(423) 239-9122

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Preston S. Douglas, DC Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 1

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

• Preston S Douglas, DC

  • Chiropractor
  • Kingsport, TN
  • NPI 1922696780
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1636416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1932865409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4012 FORT HENRY DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376632028",
            "telephone_number": "423-502-3776",
            "fax_number": "423-239-7991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PROFESSIONAL PARK PVT DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376632288",
            "telephone_number": "423-239-9122",
            "fax_number": "423-239-7991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATE SPORT AND SPINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-09",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "PRESTON",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/CEO/CHIROPRACTOR",
        "authorized_official_telephone_number": "423-239-9122",
        "authorized_official_credential": "DC, CCSP, ATC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q070613",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Preston S. Douglas, DC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dr. Preston S. Douglas, DC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Chiropractor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.