Provider Demographics
NPI:1467327130
Name:ELITE SPORT AND SPINE CENTER
Entity type:Organization
Organization Name:ELITE SPORT AND SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAVELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HANDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-879-2994
Mailing Address - Street 1:3016 WILLIAMS DR STE 203
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4616
Mailing Address - Country:US
Mailing Address - Phone:571-531-0825
Mailing Address - Fax:
Practice Address - Street 1:3016 WILLIAMS DR STE 203
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4616
Practice Address - Country:US
Practice Address - Phone:571-531-0825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty