Provider Demographics
NPI:1144407255
Name:SEGAL, ELLIOTT MARSHALL (DC)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:MARSHALL
Last Name:SEGAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 EASTBROOK BND
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1530
Mailing Address - Country:US
Mailing Address - Phone:770-487-7970
Mailing Address - Fax:770-486-5151
Practice Address - Street 1:14 EASTBROOK BND
Practice Address - Street 2:SUITE 204
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1530
Practice Address - Country:US
Practice Address - Phone:770-487-7970
Practice Address - Fax:770-486-5151
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor