# ELITE SPINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639698269
- **Authorized official:** RACHEL NAKAYAMA (OWNER)
- **Authorized official phone:** (386) 872-2929

## Contact information

- **Practice address:** 800 DUNLAWTON AVE STE 103, PORT ORANGE, FL 32127-4249
- **Practice address phone:** (386) 265-0102
- **Practice address fax:** (386) 401-2316
- **Mailing address:** 800 DUNLAWTON AVE STE 103, PORT ORANGE, FL 32127-4249
- **Mailing address phone:** (386) 265-0102
- **Mailing address fax:** (386) 401-2316

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | CH12049 | FL | Yes |

## Other

- **Enumeration date:** 09/14/2017
- **Last updated:** 10/04/2021