Provider Demographics
NPI:1083746812
Name:ELDER, JULIE KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:KAY
Last Name:ELDER
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 1:119 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:CHATFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55923-1253
Mailing Address - Country:US
Mailing Address - Phone:507-867-3558
Mailing Address - Fax:
Practice Address - Street 1:119 MAIN ST S
Practice Address - Street 2:
Practice Address - City:CHATFIELD
Practice Address - State:MN
Practice Address - Zip Code:55923-1253
Practice Address - Country:US
Practice Address - Phone:507-867-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN001873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN39251ELOtherBLUE CROSS BLUE SHIELD
MN4948271Medicaid