Provider Demographics
NPI:1093804494
Name:PEKUROVSKY, ELENA S (DC, DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:S
Last Name:PEKUROVSKY
Suffix:
Gender:F
Credentials:DC, DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17710 35TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1172
Mailing Address - Country:US
Mailing Address - Phone:612-242-1335
Mailing Address - Fax:
Practice Address - Street 1:8421 WAYZATA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1392
Practice Address - Country:US
Practice Address - Phone:612-242-1335
Practice Address - Fax:866-420-3717
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3627111N00000X
MN1582171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5110285Medicaid
MN543716400Medicaid
MN528K1PEOtherBCBS INDIVIDUAL PROVIDER
MN44-01147OtherMEDICA
MN527K1AMOtherBCBS IDENTIFICATION #