Provider Demographics
NPI:1003995879
Name:FIDEL, ILENE ELKINS (DC)
Entity Type:Individual
Prefix:DR
First Name:ILENE
Middle Name:ELKINS
Last Name:FIDEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6414 PARK HEIGHTS AVENUE
Mailing Address - Street 2:SUITE G1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-358-0060
Mailing Address - Fax:410-358-0103
Practice Address - Street 1:6414 PARK HEIGHTS AVENUE
Practice Address - Street 2:G1
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-358-0060
Practice Address - Fax:410-358-0103
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01323111N00000X
MDS01323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD251N280GMedicare ID - Type Unspecified
MDU93881Medicare UPIN