Provider Demographics
NPI:1144623687
Name:ELEVATE HEALTH CAMBRIDGE
Entity type:Organization
Organization Name:ELEVATE HEALTH CAMBRIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MEANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-605-0024
Mailing Address - Street 1:2285 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1260
Mailing Address - Country:US
Mailing Address - Phone:617-299-6534
Mailing Address - Fax:
Practice Address - Street 1:72 BAKERSFIELD ST UNIT 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02125-1901
Practice Address - Country:US
Practice Address - Phone:317-604-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA003211601Medicare PIN