Provider Demographics
NPI:1023206554
Name:ELLIOTT, TODD J (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:J
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 S WABASH ST
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-4121
Mailing Address - Country:US
Mailing Address - Phone:260-563-2222
Mailing Address - Fax:260-569-0579
Practice Address - Street 1:1940 S WABASH ST
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-4121
Practice Address - Country:US
Practice Address - Phone:260-563-2222
Practice Address - Fax:260-569-0579
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200131390BMedicaid
IN66149Medicare UPIN
IN200131390BMedicaid