Provider Demographics
NPI:1235975756
Name:ELEMENTAL WELLNESS AND SPINE PC
Entity type:Organization
Organization Name:ELEMENTAL WELLNESS AND SPINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-743-1528
Mailing Address - Street 1:21430 CEDAR DR STE 226
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-8697
Mailing Address - Country:US
Mailing Address - Phone:703-444-3870
Mailing Address - Fax:
Practice Address - Street 1:21430 CEDAR DR STE 226
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-8697
Practice Address - Country:US
Practice Address - Phone:703-444-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty