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Organization
ELITE SPINE LLC
Active
Organization
ELITE SPINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RACHEL NAKAYAMA (OWNER)
(386) 872-2929
Entity
Organization
Contact information
Practice address
800 DUNLAWTON AVE STE 103, PORT ORANGE, FL 32127-4249
(386) 265-0102
(386) 401-2316
Mailing address
800 DUNLAWTON AVE STE 103, PORT ORANGE, FL 32127-4249
(386) 265-0102
(386) 401-2316
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
CH12049
FL
Other
Enumeration date
09/14/2017
Last updated
10/04/2021
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